Provider Demographics
NPI:1235334244
Name:LAUTERS, JED MICHAEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JED
Middle Name:MICHAEL
Last Name:LAUTERS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11481 SW HALL BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:4242 COMMERCE ST
Practice Address - Street 2:STE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5412
Practice Address - Country:US
Practice Address - Phone:541-484-9632
Practice Address - Fax:541-484-7466
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR5420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138578Medicare PIN