Provider Demographics
NPI:1093044711
Name:PENNINGTON, JENNIFER ANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2204 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6306
Mailing Address - Country:US
Mailing Address - Phone:760-477-1350
Mailing Address - Fax:760-754-6785
Practice Address - Street 1:2204 S EL CAMINO REAL
Practice Address - Street 2:SUITE 102
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6306
Practice Address - Country:US
Practice Address - Phone:760-477-1350
Practice Address - Fax:760-754-6785
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist