Provider Demographics
NPI:1588142772
Name:JAYRED, PATRICIA (DPT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:JAYRED
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 1:3621 HIGHWAY 101 N
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4321
Mailing Address - Country:US
Mailing Address - Phone:503-717-7789
Mailing Address - Fax:
Practice Address - Street 1:3621 HIGHWAY 101 N
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4321
Practice Address - Country:US
Practice Address - Phone:503-717-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist