Provider Demographics
NPI:1841283777
Name:MARSTON, JENNIFER SANTOS (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SANTOS
Last Name:MARSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1913
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:360-604-1757
Practice Address - Street 1:700 NE 87TH AVE
Practice Address - Street 2:STE. 350
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1913
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1757
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008508225100000X
TX1231463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8949742OtherL & I CRIME VICTIMS
WA8496358Medicaid
WA8949742OtherL & I CRIME VICTIMS