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General NPI Number Information
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NPI Number | 1881502565
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Entity Type | Individual
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Provider Name | JENNIFER OPAL ROWAN PTA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/01/2026
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Provider Practice Location Address
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Address Line | 12441 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-1053
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Country | US
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Telephone | 503-255-7040
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Fax |
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Provider Business Mailing Address
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Address Line | 126 KONCER DR
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City | MARTINSBURG
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State | WV
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Zip | 25404-1309
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Country | US
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Telephone | 301-302-2399
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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 | CP061995A
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA003104
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License Number State | WV
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