Doctor Name: | JERRY DUANE NICKELL |
NPI Number: | 1235480948 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 1635 |
Business Practice Address: | 3325 Pocahontas Rd Baker City, OR - 978141464 |
Business Phone Number: | 5415238106 |
Business Fax Number: | 5415238151 |
Mailing Address: | 3325 Pocahontas Rd, BAKER CITY |
State: | OR |
Postal Code: | 978141464 |
Phone Number: | 5415238106 |
Fax Number: | 5415238151 |
NPI Enumeration Date: | 09/21/2012 |
NPI Last Update Date: | 09/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 1635 |
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 |