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NPI Code Detail

MEDICARE: MRS. JENNIFER ANN HARGIS DPT

MEDICARE: MRS. JENNIFER ANN HARGIS DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4970OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215086079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER ANN HARGIS DPT
Provider Business Mailing Address
First Line : 12948 SE WINSTON RD
Second Line :
City : DAMASCUS
State : OR
Zip : 97089-7606
Country : US
Telephone Number : 503-895-1320
Fax Number : 503-296-2319
Provider Business Practice Location Address
First Line : 7203 SE RAYMOND ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-4323
Country : US
Telephone Number : 503-895-1320
Fax Number : 503-296-2319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 02/08/2014

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Directions to “ MRS. JENNIFER ANN HARGIS DPT” Practice Location

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