Provider Demographics
NPI:1841363249
Name:BLEACHER, JERALD SHAWN (PT,MSPT)
Entity type:Individual
Prefix:MR
First Name:JERALD
Middle Name:SHAWN
Last Name:BLEACHER
Suffix:
Gender:M
Credentials:PT,MSPT
Other - Prefix:MISS
Other - First Name:JAKE
Other - Middle Name:SHAWN
Other - Last Name:BLEACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1166 S GILBERT RD
Mailing Address - Street 2:STE. 118
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3460
Mailing Address - Country:US
Mailing Address - Phone:148-050-7202
Mailing Address - Fax:480-539-4748
Practice Address - Street 1:1166 S GILBERT RD
Practice Address - Street 2:STE. 118
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3460
Practice Address - Country:US
Practice Address - Phone:148-050-7202
Practice Address - Fax:480-539-4748
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4328225100000X
OH011759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist