Healthcare Provider Details

I. General information

NPI: 1699366187
Provider Name (Legal Business Name): JANESSA MARIA HUNTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 SLAUSON AVE STE H
WHITTIER CA
90606-2835
US

IV. Provider business mailing address

480 FERRARA CT APT 204
POMONA CA
91766-0970
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-5449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number11162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: