Provider Demographics
NPI:1609191766
Name:OUSLEY-TREVETT, JENNIFER R (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:OUSLEY-TREVETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 W GEORGIA AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6811
Mailing Address - Country:US
Mailing Address - Phone:208-463-3234
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:210 W GEORGIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5688
Practice Address - Country:US
Practice Address - Phone:208-468-5915
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist