Individual
JASON GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2416 13TH ST SE STE B, SALEM, OR 97302-2546
(503) 894-2826
Mailing address
623 GOLDEN EAGLE ST, SALEM, OR 97304-4271
(833) 764-0178
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5979
OR
Other
Enumeration date
07/01/2021
Last updated
01/27/2022
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