Provider Demographics
NPI:1124010160
Name:SAMPSON, JONATHAN P (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:SAMPSON
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 1:62593 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9553
Mailing Address - Country:US
Mailing Address - Phone:541-318-6355
Mailing Address - Fax:541-388-9236
Practice Address - Street 1:364 SE WILSON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1711
Practice Address - Country:US
Practice Address - Phone:541-388-2681
Practice Address - Fax:541-388-9236
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist