Provider Demographics
NPI:1528264710
Name:JUHL, JERRY FRANK (PT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:FRANK
Last Name:JUHL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1845 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3467
Mailing Address - Country:US
Mailing Address - Phone:909-890-9030
Mailing Address - Fax:909-890-4393
Practice Address - Street 1:46900 MONROE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4827
Practice Address - Country:US
Practice Address - Phone:760-289-3010
Practice Address - Fax:760-863-1871
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA195376Medicare PIN