Individual
JERIMIAH MACDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4206
NM
Other
Enumeration date
08/19/2013
Last updated
08/19/2013
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