Provider Demographics
NPI: | 1477657682 |
---|---|
Name: | JENNINGS, SUSAN A (PT) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | SUSAN |
Middle Name: | A |
Last Name: | JENNINGS |
Suffix: | |
Gender: | F |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | SUSAN |
Other - Middle Name: | |
Other - Last Name: | DALZELL |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 7779 |
Mailing Address - Street 2: | |
Mailing Address - City: | VISALIA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93290-7779 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 559-582-1027 |
Mailing Address - Fax: | 559-582-8105 |
Practice Address - Street 1: | 5533 W HILLSDALE AVE STE A |
Practice Address - Street 2: | |
Practice Address - City: | VISALIA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93291-5138 |
Practice Address - Country: | US |
Practice Address - Phone: | 559-733-2478 |
Practice Address - Fax: | 559-733-2470 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-08 |
Last Update Date: | 2017-12-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PT11414 | 225100000X, 2251E1200X, 2251G0304X, 2251H1200X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | P68001 | Medicare UPIN | |
CA | 0PT114140 | Medicare PIN |