Provider Demographics
NPI:1023105327
Name:BRESNAHAN, JEFFREY R (MPT, DPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:12509 E. MISSION AVE.
Practice Address - Street 2:STE. 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-444-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00009538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8422628Medicaid
WAP00704709OtherRR MEDICARE
WAP007047019OtherRR MEDICARE
WAP00704709OtherRR MEDICARE