Provider Demographics
NPI:1477265338
Name:SEGAR, JENNIFER HENDERSON (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HENDERSON
Last Name:SEGAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5519
Mailing Address - Country:US
Mailing Address - Phone:209-466-0456
Mailing Address - Fax:
Practice Address - Street 1:442 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5519
Practice Address - Country:US
Practice Address - Phone:209-466-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant