Basic Information
| Provider Information | |||||||||
| NPI: | 1447482385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUNOLD | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RHAE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WANGERIN | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | RHAE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1815 SW MARLOW | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 SW MARLOW | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972255185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032920765 | ||||||||
| FaxNumber: | 5032925208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 06001 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.