Healthcare Provider Details

I. General information

NPI: 1477496180
Provider Name (Legal Business Name): JACQUELINE COUSINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 SAN BRUNO AVE
SAN FRANCISCO CA
94110-3527
US

IV. Provider business mailing address

1357 SAN BRUNO AVE
SAN FRANCISCO CA
94110-3527
US

V. Phone/Fax

Practice location:
  • Phone: 408-444-0054
  • Fax:
Mailing address:
  • Phone: 408-444-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: