Provider Demographics
NPI:1679522940
Name:JAMES, RENEE L (MPT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:JAMES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:L
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29871 SW CAMELOT ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7565
Mailing Address - Country:US
Mailing Address - Phone:503-707-5996
Mailing Address - Fax:
Practice Address - Street 1:29174 SW TOWN CENTER LOOP W STE 202B
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-707-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1889225100000X
OR048112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241742Medicaid
145995Medicare UPIN
OR241742Medicaid
102607Medicare UPIN