Provider Demographics
NPI:1710075619
Name:MANFORD E. ANLIKER
Entity Type:Organization
Organization Name:MANFORD E. ANLIKER
Other - Org Name:BLUE MOUNTAIN VALLEY PHYSICAL THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MANFORD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANLIKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS PT
Authorized Official - Phone:541-938-5553
Mailing Address - Street 1:113 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-1342
Mailing Address - Country:US
Mailing Address - Phone:541-938-5553
Mailing Address - Fax:541-938-5554
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1342
Practice Address - Country:US
Practice Address - Phone:541-938-5553
Practice Address - Fax:541-938-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7312507Medicaid
OR281923Medicaid
WA7312507Medicaid