Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1417539917 |
---|---|
Provider Name | Mr. Jacob William Striejewske |
First Address | Salem, OR 97302-4560 |
Second Address | Salem, OR 97302-4560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2021 |
Last Update Date | 23/04/2021 |