Individual
JERRY CLIFTON IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4 S MAIN ST STE B, JOSEPH, OR 97846-8434
(541) 432-1480
(541) 432-1481
Mailing address
PO BOX 355, ENTERPRISE, OR 97828-0355
(541) 426-4870
(541) 426-4872
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2125
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016852
—
OR
Enumeration date
04/06/2006
Last updated
01/16/2020
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