Provider Demographics
NPI:1740616291
Name:JANKY, MARCUS SCOTT (PTA)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:SCOTT
Last Name:JANKY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-0157
Mailing Address - Country:US
Mailing Address - Phone:541-863-6571
Mailing Address - Fax:541-863-7803
Practice Address - Street 1:213 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9139
Practice Address - Country:US
Practice Address - Phone:541-863-6571
Practice Address - Fax:541-863-7803
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08946225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant