Provider Demographics
NPI:1619911534
Name:ALTER, BRUCE (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ALTER
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 1:3104 NE 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1847
Mailing Address - Country:US
Mailing Address - Phone:503-280-0380
Mailing Address - Fax:971-327-8729
Practice Address - Street 1:3104 NE 49TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1847
Practice Address - Country:US
Practice Address - Phone:503-280-0380
Practice Address - Fax:971-327-8729
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics