MEDICARE: JIZELLE CASTANEDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1790523678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIZELLE CASTANEDA

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD STE 300
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	503-443-6156
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 SE CESAR E CHAVEZ BLVD STE C
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3581
Country	:	US
Telephone Number	:	503-774-3602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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Directions to “ JIZELLE CASTANEDA ” Practice Location

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