1932187689 NPI number — BEND PHYSICAL THERAPY ASSOCIATES

Table of content: (NPI 1932187689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932187689 NPI number — BEND PHYSICAL THERAPY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEND PHYSICAL THERAPY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAI CENTRAL OREGON REDMOND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932187689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11481 SW HALL BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-8403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-219-8835
Provider Business Mailing Address Fax Number:
503-443-1402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 NW LARCH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97756-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-923-7494
Provider Business Practice Location Address Fax Number:
541-504-9153
Provider Enumeration Date:
01/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIFFORD
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
800-219-8835

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 197671000 . This is a "OWCP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".