Provider Demographics
NPI:1154636173
Name:DEMMERT, JEFFREY DOUGLAS (DPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DOUGLAS
Last Name:DEMMERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1729
Mailing Address - Country:US
Mailing Address - Phone:360-354-0585
Mailing Address - Fax:360-354-1098
Practice Address - Street 1:4602 E 42ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1593
Practice Address - Country:US
Practice Address - Phone:509-863-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPU60171553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist