Provider Demographics
NPI:1588641054
Name:PAULUS, BRET (PT)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:PAULUS
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 1:1120 PINE ST.
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1972
Mailing Address - Country:US
Mailing Address - Phone:541-386-1206
Mailing Address - Fax:541-386-1208
Practice Address - Street 1:1120 PINE ST.
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1972
Practice Address - Country:US
Practice Address - Phone:541-386-1206
Practice Address - Fax:541-386-1208
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006457Medicaid
107487Medicare ID - Type Unspecified
R13907Medicare UPIN