Jennifer Mallonga, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT291396 Issued in CA

Practice address

2901 Park Ave
Ste B1
Soquel, CA 95073-2831

Phone

(831) 706-2085

Fax

(831) 417-3799

NPI assigned

Jul 8, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Luis Physical Therapy & Orthopedic Rehabilitation Inc

  dba Movement For Life Physical Therapy

  • Physical Therapy Clinic/Center
  • Atascadero, CA
  • NPI 1225046824

  Physical Therapist

  NPD (past)
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc

  dba Movement For Life Physical Therapy

  • Physical Therapy Clinic/Center
  • Pismo Beach, CA
  • NPI 1235147828

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467936000000",
    "number": "1619329182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 WALNUT ST",
            "address_2": "SUITE 110",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012416",
            "telephone_number": "805-788-0805",
            "fax_number": "805-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 PARK AVE",
            "address_2": "STE B1",
            "city": "SOQUEL",
            "state": "CA",
            "postal_code": "950732831",
            "telephone_number": "831-706-2085",
            "fax_number": "831-417-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLONGA",
        "first_name": "JENNIFER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT291396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Lin Acupuncture
• Richard Myles Litvak
• Matthew Lowe
• Laurie Marie Luker, D.C.
• Faye Lynne, FNP-C
• Steve Brian Mann, DDS
• Laura J Manning, LCSW
• Marsea S. Marcus, LMFT
• Shirley Laden Marcus, LMFT
• Paige Lorraine Marshall, RADT

• Physical Therapist in Soquel, CA
• Providers in Soquel, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; 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.