Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 62605 | OR |
N | 2251S0007X | Physical Therapist - Sports | 5136 | CO |
Y | 2251S0007X | Physical Therapist - Sports | 62605 | OR |
NPI | 1407027352 |
---|---|
Provider Name | Jeffrey Paul Guerra |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 13/04/2020 |