Provider Demographics
NPI:1821205642
Name:MANGERS, BRUCE KENNETH (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KENNETH
Last Name:MANGERS
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 1:815 NW 9TH ST
Mailing Address - Street 2:SUITE180
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6173
Mailing Address - Country:US
Mailing Address - Phone:541-768-5157
Mailing Address - Fax:541-768-5080
Practice Address - Street 1:815 NW 9TH ST
Practice Address - Street 2:SUITE180
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6173
Practice Address - Country:US
Practice Address - Phone:541-768-5157
Practice Address - Fax:541-768-5080
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist