Provider Demographics
NPI:1619111846
Name:ANGELO, JENNIFER L (PT, DPT, OCS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:ANGELO
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 BUENA VISTA RD STE 690
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8793
Mailing Address - Country:US
Mailing Address - Phone:661-282-8737
Mailing Address - Fax:661-735-5581
Practice Address - Street 1:4605 BUENA VISTA RD STE 690
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8793
Practice Address - Country:US
Practice Address - Phone:661-282-8737
Practice Address - Fax:661-735-5581
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355782251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20110ZOtherZZZ20110Z
CABW437ZMedicare PIN