Individual
JERED NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4242 COMMERCE ST STE A, EUGENE, OR 97402-5418
(541) 484-9632
(541) 484-7466
Mailing address
16083 SW UPPER BOONES FERRY RD STE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62640
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500741385
—
OR
Enumeration date
03/12/2018
Last updated
04/12/2018
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