Provider Demographics
NPI:1154524759
Name:MURRAY, JENISE DEBORAH (PT)
Entity type:Individual
Prefix:MRS
First Name:JENISE
Middle Name:DEBORAH
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 SITIO GRANADO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6976
Mailing Address - Country:US
Mailing Address - Phone:910-200-4946
Mailing Address - Fax:
Practice Address - Street 1:7930 SITIO GRANADO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6976
Practice Address - Country:US
Practice Address - Phone:910-200-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist