Individual
JAY FASTEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5601 SE 122ND AVE, PORTLAND, OR 97236-4601
(503) 761-3181
Mailing address
14005 SE 20TH ST, VANCOUVER, WA 98683-7638
(360) 393-0176
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09022
OR
225200000X
Physical Therapy Assistant
P1 60427509
WA
Other
Enumeration date
09/01/2014
Last updated
09/03/2014
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