Provider Demographics
NPI:1215416938
Name:MEDINA, JENNIFER CELINE WU (RPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER CELINE
Middle Name:WU
Last Name:MEDINA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:JENNIFER CELINE
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:13730 ASTROS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3298
Mailing Address - Country:US
Mailing Address - Phone:210-621-7208
Mailing Address - Fax:
Practice Address - Street 1:404 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064
Practice Address - Country:US
Practice Address - Phone:830-569-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2977232251G0304X
TX1249060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics