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MAILE BAY JAQUES PT
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1609107911
Individual Registrant: MAILE BAY JAQUES PT
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
28631 S WESTERN AVE SUITE 104A RANCHO PALOS VERDES, CA 90275 US
Tel: 310-548-5444 Fax: 310-548-8444
Tel: 310-548-5444 Fax: 310-548-8444
Contact information for business:
PO BOX 6384 SAN PEDRO, CA 90734-6384 US
Tel: 310-548-5444 Fax: 310-548-8444
Tel: 310-548-5444 Fax: 310-548-8444
Registration Information:
NPI: 1609107911
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | CA | |
| N | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist | CA | PT35890 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| PHYSICAL THERAPIST | PT35890 | CA | 01 |
