1801101266 NPI number — DR. JENNIFER REYNOLDS CARR DPT

Table of content: DR. JENNIFER REYNOLDS CARR DPT (NPI 1801101266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801101266 NPI number — DR. JENNIFER REYNOLDS CARR DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
JENNIFER
Provider Middle Name:
REYNOLDS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801101266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-828-2188
Provider Business Mailing Address Fax Number:
310-829-1379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-828-2188
Provider Business Practice Location Address Fax Number:
310-829-1379
Provider Enumeration Date:
08/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  36908 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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