Basic Information
| Provider Information | |||||||||
| NPI: | 1467574012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGLETON-DORAN | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SINGLETON-DORAN | ||||||||
| OtherFirstName: | JEANNE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 32840 PACIFIC COAST HWY. | ||||||||
| Address2: | MONARCH BAY PLAZA, SUITE P | ||||||||
| City: | DANA POINT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926293440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496618886 | ||||||||
| FaxNumber: | 9496615662 | ||||||||
| Practice Location | |||||||||
| Address1: | 32840 PACIFIC COAST HWY. | ||||||||
| Address2: | MONARCH BAY PLAZA, SUITE P | ||||||||
| City: | DANA POINT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926293440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496618886 | ||||||||
| FaxNumber: | 9496615662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 07/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT9494 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT9494 | 01 | CA | STATE OF CA DEPT OF CONSU | OTHER |