Provider Demographics
NPI:1669454799
Name:MERRIFIELD, GEORGIA RUOT (PT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:RUOT
Last Name:MERRIFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:RUOT
Other - Last Name:BLESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:404 NE PENN AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4264
Mailing Address - Country:US
Mailing Address - Phone:541-318-7041
Mailing Address - Fax:541-388-3711
Practice Address - Street 1:404 NE PENN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4264
Practice Address - Country:US
Practice Address - Phone:541-318-7041
Practice Address - Fax:541-388-3711
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5512828OtherFIRST HEALTH
OR231986Medicaid
331489OtherPROVIDENCE
ORH254806OtherPACIFIC SOURCE
331489OtherPROVIDENCE