Active NPI
Brenda Jacob, PTA
- Physical Therapy Assistant
- Milwaukie, OR
National Provider Identifier
1588063366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 08569
- Practice address
- 12045 SE Stanley Ave
Milwaukie, OR 97222-2938 - Phone
- (503) 659-2323
- NPI assigned
- Aug 18, 2014
- Last updated
- Aug 18, 2014
- 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 | 08569 | OR | Primary |
Addresses
Primary practice location
12045 SE Stanley Ave
Milwaukie, OR 97222-2938
Mailing address
6111 SW Beaverton Hillsdale Hwy Apt 18
Portland, OR 97221-1161
Phone (971) 226-1391
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 |
|---|---|---|---|
| 08569 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408320000000",
"number": "1588063366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6111 SW BEAVERTON HILLSDALE HWY APT 18",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972211161",
"telephone_number": "971-226-1391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12045 SE STANLEY AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972222938",
"telephone_number": "503-659-2323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "BRENDA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-18",
"last_updated": "2014-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "08569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.