Healthcare Provider Details

I. General information

NPI: 1881502565
Provider Name (Legal Business Name): JENNIFER OPAL ROWAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12441 SE STARK ST
PORTLAND OR
97233-1053
US

IV. Provider business mailing address

126 KONCER DR
MARTINSBURG WV
25404-1309
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-7040
  • Fax:
Mailing address:
  • Phone: 301-302-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP061995A
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003104
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: