MEDICARE: MR. JERALD SHAWN BLEACHER PT,MSPT

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
1	225100000X	Physical Therapist	4328	AZ
2	225100000X	Physical Therapist	011759	OH

General Provider Information

NPI Number	:	1841363249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERALD SHAWN BLEACHER PT,MSPT

Provider Business Mailing Address
First Line	:	1166 S GILBERT RD
Second Line	:	STE. 118
City	:	GILBERT
State	:	AZ
Zip	:	85296-3460
Country	:	US
Telephone Number	:	148-050-7202
Fax Number	:	480-539-4748

Provider Business Practice Location Address
First Line	:	1166 S GILBERT RD
Second Line	:	STE. 118
City	:	GILBERT
State	:	AZ
Zip	:	85296-3460
Country	:	US
Telephone Number	:	148-050-7202
Fax Number	:	480-539-4748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JERALD SHAWN BLEACHER PT,MSPT” Practice Location

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