Active NPI
Jenise Lynn Axberg, PTA
- Physical Therapy Assistant
- Creswell, OR
National Provider Identifier
1386955953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 8716
- Practice address
- 525 S 2ND St
Creswell, OR 97426-9508 - Phone
- (541) 895-3333
- NPI assigned
- Jun 28, 2010
- Last updated
- Aug 9, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | AT 3837 | CA | |
| Physical Therapy Assistant | 225200000X | 8716 | OR | Primary |
Addresses
Primary practice location
525 S 2ND St
Creswell, OR 97426-9508
Mailing address
PO Box 426
150 N. Mill St
Creswell, OR 97426-0426
Phone (707) 954-7660
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 |
|---|---|---|---|
| AT 3837 | CA | MD | Physical Therapy Assistant |
| 8716 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1386955953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 426",
"address_2": "150 N. MILL ST",
"city": "CRESWELL",
"state": "OR",
"postal_code": "974260426",
"telephone_number": "707-954-7660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 S 2ND ST",
"city": "CRESWELL",
"state": "OR",
"postal_code": "974269508",
"telephone_number": "541-895-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AXBERG",
"first_name": "JENISE",
"middle_name": "LYNN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-28",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "AT 3837",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "8716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Creswell, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.