Individual
JERRY MICHAELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
4560 SE INTERNATIONAL WAY, CONSONUS REHAB SERVICES, MILWAUKIE, OR 97222
(971) 206-5140
(971) 206-5209
Mailing address
4560 SE INTERNATIONAL WAY, MILWAUKIE, OR 97222
(971) 206-5140
(971) 206-5209
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3621
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113949
PTIP# MEDICARE PART B#
OR
01
—
182857
OMAP #
OR
Enumeration date
09/27/2006
Last updated
07/08/2007
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