Individual
JILLIAN HANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
10330 SE 32ND AVE, MILWAUKIE, OR 97222-6587
(503) 513-8600
Mailing address
516 SE 41ST AVE, PORTLAND, OR 97214-3221
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11320996900
PROVIDENCE HEALTH PLAN
OR
Enumeration date
07/30/2018
Last updated
07/30/2018
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