Provider Demographics
NPI:1962742064
Name:MCGRORY, JESSICA (LMT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MCGRORY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NW 188TH AVE
Mailing Address - Street 2:APT 3223
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7039
Mailing Address - Country:US
Mailing Address - Phone:503-314-0491
Mailing Address - Fax:
Practice Address - Street 1:1500 NW BETHANY BLVD
Practice Address - Street 2:STE 135
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5208
Practice Address - Country:US
Practice Address - Phone:503-645-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17331225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist