Provider Demographics
NPI:1902986409
Name:HASSIBI, JENNIFER PORTER (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PORTER
Last Name:HASSIBI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5140
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:4560 SE INTERNATIONAL WAY
Practice Address - Street 2:CONSONUS REHAB SERVICES
Practice Address - City:MILWAUKEE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:971-206-5140
Practice Address - Fax:971-206-5209
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist