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General NPI Number Information
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NPI Number | 1417154089
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Entity Type | Individual
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Provider Name | JENNIFER MARIE STAFFORD P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5 HARRIS CT BUILDING T SUITE 102
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City | MONTEREY
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State | CA
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Zip | 93940-5750
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Country | US
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Telephone | 831-372-3579
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Fax | 831-372-3779
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Provider Business Mailing Address
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Address Line | 4303 GOLDEN OAKS LN
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City | MONTEREY
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State | CA
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Zip | 93940-8015
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Country | US
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Telephone | 916-591-6534
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Fax |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 33751
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License Number State | CA
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