Provider Demographics
NPI:1346283397
Name:FRESHNER, JAMES WAYNE (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WAYNE
Last Name:FRESHNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15973 NW GRAF ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9212
Mailing Address - Country:US
Mailing Address - Phone:503-614-1829
Mailing Address - Fax:
Practice Address - Street 1:4800 NE BELKNAP CT
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6441
Practice Address - Country:US
Practice Address - Phone:503-268-4550
Practice Address - Fax:503-268-4551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR243049Medicaid