Provider Demographics
NPI:1043448814
Name:PFAFF, JACKLIN (PT, MPT, DSC)
Entity type:Individual
Prefix:
First Name:JACKLIN
Middle Name:
Last Name:PFAFF
Suffix:
Gender:
Credentials:PT, MPT, DSC
Other - Prefix:
Other - First Name:JACKLIN
Other - Middle Name:
Other - Last Name:MATKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT, DSC
Mailing Address - Street 1:1521 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3734
Mailing Address - Country:US
Mailing Address - Phone:323-326-0890
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE # 10220
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-289-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35605225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist