Provider Demographics
NPI:1093714701
Name:WORLEY, NANCY J (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:WORLEY
Suffix:
Gender:F
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424
Mailing Address - Country:US
Mailing Address - Phone:541-942-7000
Mailing Address - Fax:541-942-5550
Practice Address - Street 1:1445 GATEWAY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424
Practice Address - Country:US
Practice Address - Phone:541-942-7000
Practice Address - Fax:541-942-5550
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0440OR208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182252Medicaid
S97613Medicare UPIN
OR182252Medicaid