Provider Demographics
NPI:1881757359
Name:EVANS, JENNIFER BALLENTINE (PT, DPT, WCS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BALLENTINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT, DPT, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7348
Mailing Address - Country:US
Mailing Address - Phone:805-644-1591
Mailing Address - Fax:805-644-1593
Practice Address - Street 1:1889 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7348
Practice Address - Country:US
Practice Address - Phone:805-644-1591
Practice Address - Fax:805-644-1593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO939AMedicare PIN