Provider Demographics
NPI:1598848525
Name:CASTANEDA, JENA MAE BAWE (PT)
Entity Type:Individual
Prefix:MISS
First Name:JENA MAE
Middle Name:BAWE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3250 LOMITA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5014
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5414
Practice Address - Street 1:39775 SUNROSE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4126
Practice Address - Country:US
Practice Address - Phone:951-813-5297
Practice Address - Fax:951-677-7309
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8228225200000X
CAPT34378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant