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General NPI Number Information
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NPI Number | 1417735168
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Entity Type | Individual
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Provider Name | JENNIE DEIGNAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 197 AVENIDA LA PATA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6307
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Country | US
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Telephone | 949-401-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 5 GEMA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-9409
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 304469
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License Number State | CA
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