Provider Demographics
NPI:1437206695
Name:PAULSON, JENISE LAURA (MPT)
Entity Type:Individual
Prefix:
First Name:JENISE
Middle Name:LAURA
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 MARIA LN
Mailing Address - Street 2:SUITE # 420
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5343
Mailing Address - Country:US
Mailing Address - Phone:925-295-4936
Mailing Address - Fax:
Practice Address - Street 1:1470 MARIA LN
Practice Address - Street 2:SUITE # 420
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5343
Practice Address - Country:US
Practice Address - Phone:925-295-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 23694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist