Provider Demographics
NPI:1801101266
Name:CARR, JENNIFER REYNOLDS (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REYNOLDS
Last Name:CARR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1821 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-828-2188
Mailing Address - Fax:310-829-1379
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-828-2188
Practice Address - Fax:310-829-1379
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist