Provider Demographics
NPI:1720387566
Name:DAN R NAFZIGER L P T P C
Entity Type:Organization
Organization Name:DAN R NAFZIGER L P T P C
Other - Org Name:SYLVAN HILL PHYSICAL THERAPY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAFZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:L P T P C
Authorized Official - Phone:503-297-3003
Mailing Address - Street 1:5415 SW WESTGATE DR
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2409
Mailing Address - Country:US
Mailing Address - Phone:503-297-3003
Mailing Address - Fax:503-297-9414
Practice Address - Street 1:5415 SW WESTGATE DR
Practice Address - Street 2:SUITE LL3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2409
Practice Address - Country:US
Practice Address - Phone:503-297-3003
Practice Address - Fax:503-297-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1035261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000898Medicaid
OR000898Medicaid