Provider Demographics
NPI:1972790939
Name:KLEE-BIENSTOCK, JENNIFER ILENE (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ILENE
Last Name:KLEE-BIENSTOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E ALAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3050
Mailing Address - Country:US
Mailing Address - Phone:805-687-7902
Mailing Address - Fax:805-685-8890
Practice Address - Street 1:170 LOS CARNEROS WAY
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3012
Practice Address - Country:US
Practice Address - Phone:805-968-4487
Practice Address - Fax:805-685-8890
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT23025AOtherPPIN