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General NPI Number Information
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NPI Number | 1437251204
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Entity Type | Individual
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Provider Name | JENNIFER REBECCA BLACKMAN P.T.A
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 E FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-3753
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Country | US
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Telephone | 360-690-1826
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Fax | 360-737-1409
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Provider Business Mailing Address
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Address Line | 18870 HIGHLAND DR
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City | OREGON CITY
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State | OR
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Zip | 97045-4905
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Country | US
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Telephone | 503-722-5211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8035
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License Number State | OR
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