Provider Demographics
NPI:1275765745
Name:PRICE, STEPHEN EARL (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EARL
Last Name:PRICE
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 1:1159 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2129
Mailing Address - Country:US
Mailing Address - Phone:541-881-0970
Mailing Address - Fax:541-881-0971
Practice Address - Street 1:1159 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2129
Practice Address - Country:US
Practice Address - Phone:541-881-0970
Practice Address - Fax:541-881-0971
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5707225100000X
IN05011639A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist