Provider Demographics
NPI:1033280292
Name:COX, JENNIFER A (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:COX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29620 318TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RAVENSDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98051-9554
Mailing Address - Country:US
Mailing Address - Phone:425-413-4104
Mailing Address - Fax:
Practice Address - Street 1:1830 112TH ST E
Practice Address - Street 2:SUITE D
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-3747
Practice Address - Country:US
Practice Address - Phone:253-548-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant