Provider Demographics
NPI:1891234415
Name:PEREA, JENNA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:PEREA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:27125 SIERRA HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5428
Mailing Address - Country:US
Mailing Address - Phone:661-250-9940
Mailing Address - Fax:661-250-9959
Practice Address - Street 1:11225 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1610
Practice Address - Country:US
Practice Address - Phone:818-363-9970
Practice Address - Fax:818-363-9980
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA48172225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant