Individual
MR. JEB RILEY WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
24076 SE STARK ST STE 200, GRESHAM, OR 97030-3376
(503) 491-1666
Mailing address
140 SW COLUMBIA ST APT 1502, PORTLAND, OR 97201-5887
(772) 971-1144
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
65159
OR
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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