Doctor Name: | JERRY CLIFTON IVY |
NPI Number: | 1093778680 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 2125 |
Business Practice Address: | 103 Highway 82 Suite 4 Enterprise, OR - 978286000 |
Business Phone Number: | 5414264870 |
Business Fax Number: | 5414264872 |
Mailing Address: | Po Box 355, ENTERPRISE |
State: | OR |
Postal Code: | 978280355 |
Phone Number: | 5414264870 |
Fax Number: | 5414264872 |
NPI Enumeration Date: | 04/06/2006 |
NPI Last Update Date: | 03/07/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 2125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |