Healthcare Provider Details

I. General information

NPI: 1083094049
Provider Name (Legal Business Name): SAMANTHA JETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EL CAMINO REAL CLARK BUILDING
PALO ALTO CA
94301-2302
US

IV. Provider business mailing address

2914 OPAL ST
TORRANCE CA
90503-6045
US

V. Phone/Fax

Practice location:
  • Phone: 650-853-3355
  • Fax:
Mailing address:
  • Phone: 310-779-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: