Individual
MISS ELYSE RAE JENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
598 E 13TH AVE, EUGENE, OR 97401-4267
(541) 636-3473
(541) 636-3480
Mailing address
PO BOX 1377, EUGENE, OR 97440-1377
(541) 696-3473
(541) 636-3480
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4963
OR
Other
Enumeration date
06/17/2011
Last updated
06/17/2011
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