Provider Demographics
NPI:1467854950
Name:THAI, JENNIFER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:THAI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1821 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5618
Mailing Address - Country:US
Mailing Address - Phone:310-828-2188
Mailing Address - Fax:310-829-1379
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5618
Practice Address - Country:US
Practice Address - Phone:310-828-2188
Practice Address - Fax:310-829-1379
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41658225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist