Provider Demographics
NPI:1992476501
Name:ABANTO, JENNIFER (RPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ABANTO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W DUARTE RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-7477
Mailing Address - Country:US
Mailing Address - Phone:626-826-1536
Mailing Address - Fax:
Practice Address - Street 1:1899 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1733
Practice Address - Country:US
Practice Address - Phone:626-797-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist