Provider Demographics
NPI:1275078370
Name:VINCENT, JOANNE S (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:S
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 NE SEIDL RD
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-9315
Mailing Address - Country:US
Mailing Address - Phone:503-737-4391
Mailing Address - Fax:
Practice Address - Street 1:330 NE SEIDL RD
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-9315
Practice Address - Country:US
Practice Address - Phone:503-737-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005198225100000X
OR1797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist