Provider Demographics
NPI:1104062900
Name:MILEWSKI, JACLYN DEANNA (PTA)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:DEANNA
Last Name:MILEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100 CONSONUS HEALTHCARE SERVICES
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:1122 S 216TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198
Practice Address - Country:US
Practice Address - Phone:971-206-5200
Practice Address - Fax:971-206-5203
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160061430225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant