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NPI Code Detail

MEDICARE: GUNNAR LEIGHTON JAMES SJOREN DPT

MEDICARE: GUNNAR LEIGHTON JAMES SJOREN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1104306695
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUNNAR LEIGHTON JAMES SJOREN DPT
Provider Business Mailing Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4498
Country : US
Telephone Number : 509-525-3720
Fax Number : 509-522-1593
Provider Business Practice Location Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4498
Country : US
Telephone Number : 509-525-3720
Fax Number : 509-522-1593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2018
Last Update Date : 08/15/2018

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