Provider Demographics
NPI:1437108453
Name:DEMEULENAERE, JEANNE LYNN (BA MPT)
Entity Type:Individual
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First Name:JEANNE
Middle Name:LYNN
Last Name:DEMEULENAERE
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Gender:F
Credentials:BA MPT
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Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6425
Practice Address - Country:US
Practice Address - Phone:360-874-8009
Practice Address - Fax:360-874-8010
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-10-08
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Provider Licenses
StateLicense IDTaxonomies
WAPT00009062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8350191Medicaid
WA8350191Medicaid
WAAB36381Medicare ID - Type Unspecified