Provider Demographics
NPI:1093901803
Name:WOOD, JENNIFER ROBIN (LPTA, CIMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ROBIN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LPTA, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4703
Mailing Address - Country:US
Mailing Address - Phone:503-650-4395
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 246
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5808
Practice Address - Country:US
Practice Address - Phone:800-321-7862
Practice Address - Fax:360-737-0200
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7504225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant