Provider Demographics
NPI:1114249851
Name:GAPASIN, RENAN LACSON
Entity Type:Individual
Prefix:
First Name:RENAN
Middle Name:LACSON
Last Name:GAPASIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 HIGHWAY 101
Mailing Address - Street 2:APT 13
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-8831
Mailing Address - Country:US
Mailing Address - Phone:360-980-1647
Mailing Address - Fax:
Practice Address - Street 1:1951 21ST ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9771
Practice Address - Country:US
Practice Address - Phone:541-997-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist