Provider Demographics
NPI:1326464181
Name:ZYCH, JANELLE (DPT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:ZYCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1860
Mailing Address - Country:US
Mailing Address - Phone:503-537-1863
Mailing Address - Fax:503-537-1864
Practice Address - Street 1:2480 LIBERTY ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-763-3525
Practice Address - Fax:503-763-3526
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR60489OtherPT LICENSE #