Provider Demographics
NPI:1700192606
Name:CULKIN, JACQUELYN (PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:CULKIN
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 1:26336 ARBORETUM WAY
Mailing Address - Street 2:UNIT 3705
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8380
Mailing Address - Country:US
Mailing Address - Phone:814-574-2561
Mailing Address - Fax:
Practice Address - Street 1:26336 ARBORETUM WAY
Practice Address - Street 2:UNIT 3705
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8380
Practice Address - Country:US
Practice Address - Phone:814-574-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48117225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant