Individual
BRENDA JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12045 SE STANLEY AVE, MILWAUKIE, OR 97222-2938
(503) 659-2323
Mailing address
6111 SW BEAVERTON HILLSDALE HWY APT 18, PORTLAND, OR 97221-1161
(971) 226-1391
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
08569
OR
Other
Enumeration date
08/18/2014
Last updated
08/18/2014
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