Provider Demographics
NPI:1003413550
Name:VALENTINE, JENNA (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:LE ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9204 SE MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3831
Mailing Address - Country:US
Mailing Address - Phone:503-777-6746
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:9204 SE MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3831
Practice Address - Country:US
Practice Address - Phone:503-777-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR63839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist