Provider Demographics
NPI:1295958494
Name:DE BETTIGNIES, JEAN (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:DE BETTIGNIES
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 1:2895 LOMA VISTA RD
Mailing Address - Street 2:STE H
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1542
Mailing Address - Country:US
Mailing Address - Phone:805-765-4773
Mailing Address - Fax:
Practice Address - Street 1:510 CASTILLO ST # 108
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3406
Practice Address - Country:US
Practice Address - Phone:805-451-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist