Provider Demographics
NPI:1912048216
Name:FAJARDO, JOANNA LESLEY BALUYUT (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA LESLEY
Middle Name:BALUYUT
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:200 MUIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-458-3846
Practice Address - Fax:925-458-3846
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist