Provider Demographics
NPI:1578629127
Name:KORTE, JACQUELINE JO (RPT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JO
Last Name:KORTE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ALISAL RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3735
Mailing Address - Country:US
Mailing Address - Phone:805-688-5000
Mailing Address - Fax:805-688-4615
Practice Address - Street 1:320 ALISAL RD
Practice Address - Street 2:SUITE 406
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3735
Practice Address - Country:US
Practice Address - Phone:805-688-5000
Practice Address - Fax:805-688-4615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT11324AMedicare PIN