Jacquelyn Marie Nelsen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

65115 Issued in OR

Practice address

4859 Meadows Rd Ste 161
Lake Oswego, OR 97035-2628

Phone

(503) 387-6081

Fax

(503) 908-1518

NPI assigned

Feb 19, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jacquelyn Marie Bass Former name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Therapydia, Inc.

  • Physical Therapist
  • Portland, OR
  • NPI 1346672797
  Medicare reassignment NPD
• Therapydia, Inc.

  • Physical Therapy Clinic/Center
  • Washington, DC
  • NPI 1639583602

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1912762014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 S BOND AVE APT 225",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4859 MEADOWS RD STE 161",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352628",
            "telephone_number": "503-387-6081",
            "fax_number": "503-908-1518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2808 E Burnside St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972141830",
            "country_code": "US",
            "telephone_number": "503-477-4802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSEN",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "BASS",
            "middle_name": "MARIE",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nisha Nagarkatti-Gude, MD, PHD
• National Seating & Mobility, Inc.
• Richelle Mary Neal, M.D.
• Tanya Neely
• Zachary Robert Nelms, L.AC.
• Arthur Jeffery Nelson, PA-C
• Lynae M Nelson, LPC
• Sally Lynn Nelson, R.D.H.
• Marci J Nemhauser, PSYD
• Nicole K Nesser, LMT

• Physical Therapist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.