Healthcare Provider Details

I. General information

NPI: 1609191766
Provider Name (Legal Business Name): JENNIFER R OUSLEY-TREVETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER R SANCHEZ

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W GEORGIA AVE SUITE 100
NAMPA ID
83686-5688
US

IV. Provider business mailing address

217 W GEORGIA AVE SUITE 115
NAMPA ID
83686-6811
US

V. Phone/Fax

Practice location:
  • Phone: 208-468-5915
  • Fax: 208-463-3044
Mailing address:
  • Phone: 208-463-3234
  • Fax: 208-463-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2648
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: