Provider Demographics
NPI:1689007502
Name:JACQUES, ROSS J (DPT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:J
Last Name:JACQUES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:RRMC MED STAFF
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:781 BLACK OSK DR #102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8383
Practice Address - Country:US
Practice Address - Phone:541-789-4236
Practice Address - Fax:541-789-5965
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12314-24225100000X
OR61025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist