Provider Demographics
NPI:1114288065
Name:PODREBARAC, JANE CHRISTABELLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CHRISTABELLE
Last Name:PODREBARAC
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:CHRISTABELLE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:79 E HIGHLAND AVE
Mailing Address - Street 2:APT. D
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1945
Mailing Address - Country:US
Mailing Address - Phone:626-836-3129
Mailing Address - Fax:
Practice Address - Street 1:79 E HIGHLAND AVE
Practice Address - Street 2:APT. D
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1945
Practice Address - Country:US
Practice Address - Phone:626-836-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist