Individual
JENISE LYNN AXBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
525 S 2ND ST, CRESWELL, OR 97426-9508
(541) 895-3333
Mailing address
PO BOX 426, 150 N. MILL ST, CRESWELL, OR 97426-0426
(707) 954-7660
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8716
OR
225200000X
Physical Therapy Assistant
AT 3837
CA
Other
Enumeration date
06/28/2010
Last updated
08/09/2011
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