Provider Demographics
NPI:1669715074
Name:SELLERS, JENNIFER (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 SE UMATILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7212
Mailing Address - Country:US
Mailing Address - Phone:636-288-0641
Mailing Address - Fax:
Practice Address - Street 1:16219 SE 12TH ST
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8904
Practice Address - Country:US
Practice Address - Phone:360-253-4020
Practice Address - Fax:360-604-9293
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60717340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist