Individual
JARED RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
421 S EVANS ST, MCMINNVILLE, OR 97128
(503) 472-3141
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09077
OR
Other
Enumeration date
09/03/2014
Last updated
09/03/2014
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