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General NPI Number Information
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NPI Number | 1366642555
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Entity Type | Individual
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Provider Name | JENNIFER BOCHE DPT
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Gender | Female
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 8775 AERO DR SUITE 238
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City | SAN DIEGO
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State | CA
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Zip | 92123-1792
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Country | US
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Telephone | 858-571-0030
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Fax | 858-571-0050
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Provider Business Mailing Address
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Address Line | 8775 AERO DR SUITE 238
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City | SAN DIEGO
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State | CA
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Zip | 92123-1792
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Country | US
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Telephone | 858-571-0030
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Fax | 858-571-0050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT 35653
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT011208
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License Number State | OH
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