Provider Demographics
NPI:1487871109
Name:ENGEMANN, JARED CHRISTOPHER (RPT)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:ENGEMANN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 N VULCAN AVE
Mailing Address - Street 2:#5
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1720
Mailing Address - Country:US
Mailing Address - Phone:760-815-6399
Mailing Address - Fax:
Practice Address - Street 1:981 N VULCAN AVE
Practice Address - Street 2:#5
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1720
Practice Address - Country:US
Practice Address - Phone:760-815-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist