Provider Demographics
NPI:1619575727
Name:LI, JENNY (DPT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25115 AVENUE STANFORD STE B135
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-947-9988
Practice Address - Street 1:38656 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4694
Practice Address - Country:US
Practice Address - Phone:661-947-9977
Practice Address - Fax:661-947-9988
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA298761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist