Provider Demographics
NPI:1780897751
Name:SATHER, JENNIFER (DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SATHER
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 1:25011 MONTE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1530
Mailing Address - Country:US
Mailing Address - Phone:949-429-8657
Mailing Address - Fax:
Practice Address - Street 1:901 CALLE AMANECER STE 320
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-4222
Practice Address - Country:US
Practice Address - Phone:949-366-6785
Practice Address - Fax:949-366-6470
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29961AMedicare ID - Type Unspecified