Provider Demographics
NPI:1982681391
Name:COX, JAN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIE
Last Name:COX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 E 12TH ALY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3549
Mailing Address - Country:US
Mailing Address - Phone:541-343-7996
Mailing Address - Fax:541-345-9281
Practice Address - Street 1:143 E 12TH ALY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-343-7996
Practice Address - Fax:541-345-9281
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158848Medicaid
OR117673Medicare PIN