Provider Demographics
NPI:1073778148
Name:VERDOUW, ERIK (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:
Last Name:VERDOUW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 HILYARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3815
Mailing Address - Country:US
Mailing Address - Phone:541-431-3850
Mailing Address - Fax:541-683-4031
Practice Address - Street 1:3469 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3815
Practice Address - Country:US
Practice Address - Phone:541-431-3850
Practice Address - Fax:541-683-4031
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist