Provider Demographics
NPI:1952578833
Name:REINERTSON, JAMIE LYN (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:REINERTSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 SPRUCE ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0022
Mailing Address - Country:US
Mailing Address - Phone:541-543-7121
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-589-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist