Provider Demographics
NPI:1689919151
Name:JARVIS, JUTTA
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUTTA
Other - Middle Name:M
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS/PTA
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:116 FAIRVIEW AVE. N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-254-1456
Practice Address - Fax:971-206-5203
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160283009225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant