Provider Demographics
NPI:1881840692
Name:DAVIS, JENNIFER LYNNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 S STATE ST
Mailing Address - Street 2:SUITE V #337
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3932
Mailing Address - Country:US
Mailing Address - Phone:503-482-7234
Mailing Address - Fax:503-482-7232
Practice Address - Street 1:1260 SE LAMBERT ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6386
Practice Address - Country:US
Practice Address - Phone:503-482-7234
Practice Address - Fax:503-482-7232
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-24942251X0800X
OR57272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic