Provider Demographics
NPI:1356638712
Name:KLINGLER, JEREMIAH JOSEPH (LMT)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:JOSEPH
Last Name:KLINGLER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22150 SW ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9807
Mailing Address - Country:US
Mailing Address - Phone:503-437-3212
Mailing Address - Fax:
Practice Address - Street 1:2735 20TH PL STE A
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2890
Practice Address - Country:US
Practice Address - Phone:503-357-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist