Provider Demographics
NPI:1346814936
Name:THAKKAR, JOEL (MPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 WILLAGILLESPIE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6711
Mailing Address - Country:US
Mailing Address - Phone:541-636-4471
Mailing Address - Fax:541-357-4992
Practice Address - Street 1:1144 WILLAGILLESPIE RD STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6711
Practice Address - Country:US
Practice Address - Phone:541-636-4471
Practice Address - Fax:541-357-4992
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64083225100000X
2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR64083OtherOREGON BOARD OF PHYSICAL THERAPY