Provider Demographics
NPI:1114779097
Name:HOUCK, JEFFERY RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:RICHARD
Last Name:HOUCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 MARINER CIR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3908
Mailing Address - Country:US
Mailing Address - Phone:585-402-0381
Mailing Address - Fax:
Practice Address - Street 1:414 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2697
Practice Address - Country:US
Practice Address - Phone:585-402-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR603972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic