Provider Demographics
NPI:1083804017
Name:PRENTICE, JANELLE CHRISTINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:CHRISTINE
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JANELLE
Other - Middle Name:CHRISTINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8643 NE BEECH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5012
Mailing Address - Country:US
Mailing Address - Phone:503-256-2151
Mailing Address - Fax:503-256-2154
Practice Address - Street 1:8643 NE BEECH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5012
Practice Address - Country:US
Practice Address - Phone:503-256-2151
Practice Address - Fax:503-256-2154
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8277225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant