Provider Demographics
NPI:1073710752
Name:NAULT, JENNIFER L (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:NAULT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 N HARBOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1362
Mailing Address - Country:US
Mailing Address - Phone:714-870-8478
Mailing Address - Fax:
Practice Address - Street 1:1027 N HARBOR BLVD STE B
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1362
Practice Address - Country:US
Practice Address - Phone:714-870-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist