Basic Information
| Provider Information | |||||||||
| NPI: | 1427324813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAITY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | RCEP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14830 LOS GATOS BLVD. SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083957300 | ||||||||
| FaxNumber: | 4083957350 | ||||||||
| Practice Location | |||||||||
| Address1: | 14830 LOS GATOS BLVD., SUITE 101 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083957300 | ||||||||
| FaxNumber: | 4083957350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Y00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Clinical Exercise Physiologist |
No ID Information.