Provider Demographics
NPI:1568772531
Name:SOMEILLAN, JENNIFER (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:SOMEILLAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 PONDEROSA DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8278
Mailing Address - Country:US
Mailing Address - Phone:406-920-8468
Mailing Address - Fax:
Practice Address - Street 1:1309 PONDEROSA DR STE 204
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8278
Practice Address - Country:US
Practice Address - Phone:406-920-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist