Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1574 | OR |
NPI | 1063966794 |
---|---|
Provider Name | Ms. Jennifer J Rosoff |
First Address | Portland, OR 97214-4740 |
Second Address | Portland, OR 97225-6625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2016 |
Last Update Date | 10/08/2016 |