Provider Demographics
NPI:1053924712
Name:QI, JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:QI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 EL CAMINO REAL STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3034
Mailing Address - Country:US
Mailing Address - Phone:858-793-1460
Mailing Address - Fax:
Practice Address - Street 1:11515 EL CAMINO REAL STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3034
Practice Address - Country:US
Practice Address - Phone:619-291-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305465225100000X
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist