Provider Demographics
NPI:1184192726
Name:TERNER, JOANNE RAEL
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:RAEL
Last Name:TERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13891 NEWPORT AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7840
Mailing Address - Country:US
Mailing Address - Phone:714-770-8222
Mailing Address - Fax:
Practice Address - Street 1:13891 NEWPORT AVE STE 285
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7840
Practice Address - Country:US
Practice Address - Phone:714-770-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist