Provider Demographics
NPI:1154331643
Name:JORGENSON, JOANN (PT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24302 TAHOE CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7024
Mailing Address - Country:US
Mailing Address - Phone:949-362-8837
Mailing Address - Fax:
Practice Address - Street 1:22741 LAMBERT ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1617
Practice Address - Country:US
Practice Address - Phone:949-581-3839
Practice Address - Fax:949-454-6763
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist