Individual
MISS JACKIE MARCELLA WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1111 NE 99TH AVE, PORTLAND, OR 97220
(503) 216-5410
(503) 216-5420
Mailing address
1111 NE 99TH, PORTLAND, OR 97220-9428
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5452
OR
Other
Enumeration date
08/05/2007
Last updated
07/31/2018
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