Provider Demographics
NPI:1457954802
Name:ADDLEMAN, JARRET ROBERT
Entity Type:Individual
Prefix:
First Name:JARRET
Middle Name:ROBERT
Last Name:ADDLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MERCANTILE DR STE 750
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2595
Mailing Address - Country:US
Mailing Address - Phone:503-305-7762
Mailing Address - Fax:
Practice Address - Street 1:4200 MERCANTILE DR STE 750
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2595
Practice Address - Country:US
Practice Address - Phone:503-305-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist