Provider Demographics
NPI:1184171878
Name:TRUONG, JENNIFER THU (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THU
Last Name:TRUONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 MEDICAL CTR DR
Mailing Address - Street 2:#200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7359
Mailing Address - Country:US
Mailing Address - Phone:541-706-9385
Mailing Address - Fax:541-312-5256
Practice Address - Street 1:550 SW INDUSTRIAL WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1084
Practice Address - Country:US
Practice Address - Phone:541-385-3344
Practice Address - Fax:541-678-5971
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist