Provider Demographics
NPI:1417647363
Name:TEIXEIRA, JENNIFER (CMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:CA
Mailing Address - Zip Code:95565-9724
Mailing Address - Country:US
Mailing Address - Phone:707-630-2352
Mailing Address - Fax:
Practice Address - Street 1:3034 H ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4416
Practice Address - Country:US
Practice Address - Phone:707-440-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48044225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist