Provider Demographics
NPI:1417183096
Name:HARRIETTE BASHI LLC
Entity Type:Organization
Organization Name:HARRIETTE BASHI LLC
Other - Org Name:AQUATIC HEALING ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRIETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT, LMT
Authorized Official - Phone:541-431-1215
Mailing Address - Street 1:62 RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3578
Mailing Address - Country:US
Mailing Address - Phone:541-431-1215
Mailing Address - Fax:541-431-1216
Practice Address - Street 1:62 RIDGELINE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3578
Practice Address - Country:US
Practice Address - Phone:541-431-1215
Practice Address - Fax:541-431-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3355261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy