Provider Demographics
NPI:1538410360
Name:UNTERREINER, JENNIFER (DPT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:UNTERREINER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W. WILSON ST.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-631-0125
Mailing Address - Fax:949-631-0127
Practice Address - Street 1:129 W. WILSON ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-631-0125
Practice Address - Fax:949-631-0127
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist