Active NPI
Jennifer Ann Oliver, LPTA
- Physical Therapy Assistant
- Portland, OR
National Provider Identifier
1043466493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 8004
- Practice address
- 12441 SE Stark St
Portland, OR 97233-1053 - Phone
- (503) 255-7040
- NPI assigned
- Aug 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 8004 | OR | Primary |
Addresses
Primary practice location
12441 SE Stark St
Portland, OR 97233-1053
Mailing address
5880 Rockwood CT
Lake Oswego, OR 97035-4146
Phone (503) 534-2761
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8004 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8004 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1043466493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5880 ROCKWOOD CT",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970354146",
"telephone_number": "503-534-2761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12441 SE STARK ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331053",
"telephone_number": "503-255-7040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "JENNIFER",
"middle_name": "ANN",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "8004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8004",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.