Individual
JACQUE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 OAK ST, SUITE 200, HOOD RIVER, OR 97031-2062
(541) 386-0009
Mailing address
315 OAK ST, HOOD RIVER, OR 97031-2062
(541) 386-0009
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09396
OR
225200000X
Physical Therapy Assistant
P160660710
WA
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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