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NPI Code Detail

MEDICARE: AMANDA JERKINS PT

MEDICARE: AMANDA JERKINS PT
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 Therapist63085OR

General Provider Information

NPI Number : 1790257103
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA JERKINS PT
Provider Business Mailing Address
First Line : 16083 SW UPPER BOONES FERRY RD STE 300
Second Line :
City : TIGARD
State : OR
Zip : 97224-7736
Country : US
Telephone Number : 503-443-6156
Fax Number : 503-639-9699
Provider Business Practice Location Address
First Line : 8324 SE 17TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-7307
Country : US
Telephone Number : 503-236-3837
Fax Number : 503-206-8203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2018
Last Update Date : 12/24/2018

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