Provider Demographics
NPI:1558579029
Name:MANNELIN, JANET PATRICIA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:PATRICIA
Last Name:MANNELIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 SW RIVERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-635-4496
Mailing Address - Fax:
Practice Address - Street 1:19201 SE DIVISION STREET
Practice Address - Street 2:CASCADE PHYSICAL THERAPY
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-669-2500
Practice Address - Fax:503-661-4113
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist