Provider Demographics
NPI:1912576919
Name:JOVELLANOS, ARANTXA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ARANTXA
Middle Name:
Last Name:JOVELLANOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 GRASSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1319
Mailing Address - Country:US
Mailing Address - Phone:909-967-6904
Mailing Address - Fax:
Practice Address - Street 1:255 W 7TH ST APT 10
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-0301
Practice Address - Country:US
Practice Address - Phone:909-967-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist