Provider Demographics
NPI:1588096358
Name:SCHROEDER, JENNA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20782 NW LONGBOW LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-1794
Mailing Address - Country:US
Mailing Address - Phone:580-222-1385
Mailing Address - Fax:
Practice Address - Street 1:3925 SW 153RD DR STE 210
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-4176
Practice Address - Country:US
Practice Address - Phone:971-727-8155
Practice Address - Fax:971-727-8179
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60557268225100000X
OR61771225100000X
OK4718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist