Provider Demographics
NPI:1669006540
Name:WHITACRE, JANET S (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:WHITACRE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JANI
Other - Middle Name:
Other - Last Name:WHITACRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:23400 E BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:RHODODENDRON
Mailing Address - State:OR
Mailing Address - Zip Code:97049-9710
Mailing Address - Country:US
Mailing Address - Phone:503-622-4165
Mailing Address - Fax:
Practice Address - Street 1:67211 E HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:WELCHES
Practice Address - State:OR
Practice Address - Zip Code:97067-8797
Practice Address - Country:US
Practice Address - Phone:503-622-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist