Individual
DR. JESSICA MCCONAHAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1307 NE 102ND AVE, SUITE G, PORTLAND, OR 97220-3980
(503) 253-0924
(503) 256-5469
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
61838
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500715462
—
OR
01
—
P01767083
RR MEDICARE
OR
Enumeration date
07/27/2016
Last updated
02/09/2017
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