Jennifer Daniell Pentrack, PT

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

118190 Issued in CA

Practice address

633 Lassen LN
Mount Shasta, CA 96067-9002

Phone

(530) 926-6010

Fax

(530) 926-6909

NPI assigned

Nov 19, 2009

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 19, 2009.

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1366770992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 LASSEN LN",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960679002",
            "telephone_number": "530-926-6010",
            "fax_number": "530-926-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 LASSEN LN",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960679002",
            "telephone_number": "530-926-6010",
            "fax_number": "530-926-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELL PENTRACK",
        "first_name": "JENNIFER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-19",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "118190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Mount Shasta, CA
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.