Healthcare Provider Details

I. General information

NPI: 1417871716
Provider Name (Legal Business Name): JENNA CHRISTINE SALAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MANHATTAN BEACH BLVD STE 102B
REDONDO BEACH CA
90278-1230
US

IV. Provider business mailing address

4620 S SLAUSON AVE APT 203
CULVER CITY CA
90230-5181
US

V. Phone/Fax

Practice location:
  • Phone: 310-426-9570
  • Fax: 310-426-9572
Mailing address:
  • Phone: 925-354-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: