Provider Demographics
NPI:1043448814
Name:PFAFF, JACKLIN (MPT, PCS)
Entity Type:Individual
Prefix:
First Name:JACKLIN
Middle Name:
Last Name:PFAFF
Suffix:
Gender:F
Credentials:MPT, PCS
Other - Prefix:
Other - First Name:JACKLIN
Other - Middle Name:
Other - Last Name:MATKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, PCS
Mailing Address - Street 1:1323 S CARMELINA AVE
Mailing Address - Street 2:APT 216
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1947
Mailing Address - Country:US
Mailing Address - Phone:323-326-0890
Mailing Address - Fax:
Practice Address - Street 1:1111 W 6TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1800
Practice Address - Country:US
Practice Address - Phone:323-478-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics