Individual
AIMEE LEONA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
10215 SW PARKWAY, SUITE D, PORTLAND, OR 97225-5036
(503) 292-3583
(503) 292-1022
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
3632
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
295706
—
OR
01
—
650015562
RR MEDICARE
OR
Enumeration date
11/23/2005
Last updated
06/13/2016
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