Provider Demographics
NPI:1366693889
Name:FOLK, JOHN WAYLAND (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WAYLAND
Last Name:FOLK
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:SEAL ROCK
Mailing Address - State:OR
Mailing Address - Zip Code:97376-0032
Mailing Address - Country:US
Mailing Address - Phone:541-867-6033
Mailing Address - Fax:
Practice Address - Street 1:135 NW 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3640
Practice Address - Country:US
Practice Address - Phone:541-265-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist