| Mr Jeb Riley Wild, DPT | |
|
24076 Se Stark St Ste 200, Gresham, OR 97030-3376 | |
| (503) 491-1666 | |
| Not Available |
| Full Name | Mr Jeb Riley Wild |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 24076 Se Stark St Ste 200, Gresham, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497526222 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 65159 (Oregon) | Primary |
| Provider Name | Sportscare Physical Therapy @ Cornell, LLC |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1649534793 PECOS PAC ID: 7517115579 Enrollment ID: O20120917000315 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Jeb Riley Wild, DPT 140 Sw Columbia St Apt 1502, Portland, OR 97201-5887 Ph: (772) 971-1144 | Mr Jeb Riley Wild, DPT 24076 Se Stark St Ste 200, Gresham, OR 97030-3376 Ph: (503) 491-1666 |
Namita Avarsekar, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 304 Ne Hood Ave, Gresham, OR 97030 Phone: 503-666-1333 Fax: 503-666-2444 |
Paul Song Eo, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 24076 Se Stark St Ste 200, Gresham, OR 97030 Phone: 503-491-1666 |
Rylee Pittullo, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 25500 Se Stark St Ste 103, Gresham, OR 97030 Phone: 503-328-0222 Fax: 503-328-0223 |
Mr. Clem George Eischen Jr., PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24076 Se Stark St, Gresham, OR 97030 Phone: 503-491-1666 |
Bradley Roy Eisenhut, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 283 Ne 223rd Ave, Gresham, OR 97030 Phone: 503-912-1192 |
Lindsey Soule, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 304 Ne Hood Ave Ste 100, Gresham, OR 97030 Phone: 503-666-1333 |
Kaeli Frank, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7927 Se Orient Dr, Gresham, OR 97080 Phone: 503-663-0481 |