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General NPI Number Information
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NPI Number | 1245520196
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Entity Type | Organization
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Legal Business Name | JENNINGS PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 3875 TELEGRAPH RD SUITE C
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City | VENTURA
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State | CA
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Zip | 93003-3419
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Country | US
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Telephone | 805-477-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 3875 TELEGRAPH RD SUITE C
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City | VENTURA
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State | CA
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Zip | 93003-3419
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Country | US
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Telephone | 805-477-0909
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIA JENNINGS
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Credential | RPT
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Telephone | 805-477-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT 17114
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License Number State | CA
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