Provider Demographics
NPI:1174825616
Name:GAPASIN, BUENAGRACIA (PT)
Entity Type:Individual
Prefix:
First Name:BUENAGRACIA
Middle Name:
Last Name:GAPASIN
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 1:4480 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:541-999-9326
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?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist