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General NPI Number Information
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NPI Number | 1437631009
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Entity Type | Individual
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Provider Name | JEREMY K JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 10330 SE 32ND AVE STE 105
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City | MILWAUKIE
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State | OR
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Zip | 97222-6596
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Country | US
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Telephone | 503-513-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 SE 32ND AVE STE 105
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City | MILWAUKIE
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State | OR
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Zip | 97222-6596
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 5466
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License Number State | OR
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