Provider Demographics
NPI:1013190032
Name:TANAKA, JENNIFER S (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
Last Name:TANAKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:S
Other - Last Name:TANAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8031 YORKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2026
Mailing Address - Country:US
Mailing Address - Phone:626-674-7050
Mailing Address - Fax:
Practice Address - Street 1:8031 YORKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2026
Practice Address - Country:US
Practice Address - Phone:626-674-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325972251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology