Provider Demographics
NPI:1427592872
Name:MILECK, JOCELYN (LPTA)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:MILECK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 3101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-576-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60031132225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant