Provider Demographics
NPI:1447480512
Name:STURZINGER, JENNA N (MPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:N
Last Name:STURZINGER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BILHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:685 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4741
Mailing Address - Country:US
Mailing Address - Phone:503-540-8701
Mailing Address - Fax:503-371-8772
Practice Address - Street 1:685 36TH AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4741
Practice Address - Country:US
Practice Address - Phone:503-540-8701
Practice Address - Fax:503-371-8772
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500609411Medicaid