Provider Demographics
NPI:1467435446
Name:PARR, JOHN JEFFERY (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JEFFERY
Last Name:PARR
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:519 NW DIVISION ST
Practice Address - Street 2:SUITE 220
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5527
Practice Address - Country:US
Practice Address - Phone:503-666-7644
Practice Address - Fax:503-674-9980
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269090Medicaid
OR0328953OtherWA L&I
OR0330313OtherWA L&I
OR650016939OtherRR MEDICARE
OR269090Medicaid
OR0328953OtherWA L&I
OR0330313OtherWA L&I