Provider Demographics
NPI:1902989627
Name:CHRISTIANS, PENELOPE JEAN (RPT)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:JEAN
Last Name:CHRISTIANS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CALLE EMPALME
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2105
Mailing Address - Country:US
Mailing Address - Phone:949-369-9815
Mailing Address - Fax:949-366-0497
Practice Address - Street 1:323 CALLE EMPALME
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2105
Practice Address - Country:US
Practice Address - Phone:949-369-9815
Practice Address - Fax:949-366-0497
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist