Basic Information
| Provider Information | |||||||||
| NPI: | 1093837437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | JENNINGS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2263 SE LANDING WAY | ||||||||
| Address2: | |||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977548258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414475649 | ||||||||
| FaxNumber: | 5414471243 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 NE ELM ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | PRINEVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977541206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414476846 | ||||||||
| FaxNumber: | 5414471243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0154 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.