Provider Demographics
NPI:1528440252
Name:JEFFERY, ANNE (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:SCHULENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:3400 STATE ST
Practice Address - Street 2:SUITE G-704
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5861
Practice Address - Country:US
Practice Address - Phone:800-219-8835
Practice Address - Fax:503-639-9699
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500693729Medicaid
ORR188072Medicare PIN