Individual
JERRY DUANE NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3325 POCAHONTAS RD, BAKER CITY, OR 97814-1464
(541) 523-8106
(541) 523-8151
Mailing address
3325 POCAHONTAS RD, BAKER CITY, OR 97814-1464
(541) 523-8106
(541) 523-8151
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1635
OR
Other
Enumeration date
09/21/2012
Last updated
09/21/2012
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