Individual
JEREMY M. CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
870 S FRONT ST, CENTRAL POINT, OR 97502-2779
(541) 732-8280
Mailing address
870 S FRONT ST, CENTRAL POINT, OR 97502-2779
(541) 732-8280
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4789
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081009-026
BLUECROSS BLUESHIELD
OR
05
—
275342
—
OR
Enumeration date
11/17/2005
Last updated
12/12/2011
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