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General NPI Number Information
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NPI Number | 1720916422
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Entity Type | Individual
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Provider Name | JAKE TRIANCE
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Gender | Male
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 61470 S HWY 97 STE B
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City | BEND
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State | OR
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Zip | 97702-2559
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Country | US
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Telephone | 541-508-5473
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Fax | 541-508-5474
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Provider Business Mailing Address
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Address Line | 1650 LYNDON FARM CT STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-5005
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Country | US
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Telephone | 726-202-3039
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Fax | 210-978-5592
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 66075
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License Number State | OR
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