Provider Demographics
NPI:1609843317
Name:TOKUDA, EILEEN MACKLE (PT)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MACKLE
Last Name:TOKUDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 MAIN ST
Mailing Address - Street 2:PO BOX 1360
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9725
Mailing Address - Country:US
Mailing Address - Phone:541-929-2255
Mailing Address - Fax:541-929-7055
Practice Address - Street 1:732 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9725
Practice Address - Country:US
Practice Address - Phone:541-929-2255
Practice Address - Fax:541-929-7055
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133416Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER