Individual
JAY T MIZUTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4823
(212) 606-1005
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
040302
NY
225100000X
Physical Therapist
60309
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500666742
—
OR
Enumeration date
12/16/2013
Last updated
04/09/2021
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