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NPI Code Detail

MEDICARE: GREGORY THOMAS JORGENSEN DPT

MEDICARE: GREGORY THOMAS JORGENSEN 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 Therapist5685OR

General Provider Information

NPI Number : 1417119843
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY THOMAS JORGENSEN DPT
Provider Business Mailing Address
First Line : 1627 WOODS CT
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-2915
Country : US
Telephone Number : 541-386-9511
Fax Number : 866-860-8070
Provider Business Practice Location Address
First Line : 1627 WOODS CT
Second Line :
City : HOOD RIVER
State : OR
Zip : 97031-2915
Country : US
Telephone Number : 541-386-9511
Fax Number : 866-860-8070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2008
Last Update Date : 12/18/2014

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