MEDICARE: MRS. JENNIFER ANN PENNINGTON MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	36108	CA

General Provider Information

NPI Number	:	1093044711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN PENNINGTON MPT

Provider Business Mailing Address
First Line	:	2204 S EL CAMINO REAL
Second Line	:	SUITE 102
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6306
Country	:	US
Telephone Number	:	760-477-1350
Fax Number	:	760-754-6785

Provider Business Practice Location Address
First Line	:	2204 S EL CAMINO REAL
Second Line	:	SUITE 102
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6306
Country	:	US
Telephone Number	:	760-477-1350
Fax Number	:	760-754-6785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	01/03/2013

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