Provider Demographics
NPI:1578041661
Name:MUSGRAVE, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 NW HOYT ST APT 26
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1261
Mailing Address - Country:US
Mailing Address - Phone:360-910-9265
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD
Practice Address - Street 2:STE 361
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-9720
Practice Address - Country:US
Practice Address - Phone:503-216-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR603882251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology