Healthcare Provider Details

I. General information

NPI: 1053526137
Provider Name (Legal Business Name): DAVID JONATHAN EMERSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 NE HOOD AVE
GRESHAM OR
97030-7449
US

IV. Provider business mailing address

PO BOX 182
TROUTDALE OR
97060-0182
US

V. Phone/Fax

Practice location:
  • Phone: 503-618-9760
  • Fax:
Mailing address:
  • Phone: 503-618-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number7087
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: