Provider Demographics
NPI:1912572157
Name:WEST, GARTH ALAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:ALAN
Last Name:WEST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NW 5TH ST APT 22
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6474
Mailing Address - Country:US
Mailing Address - Phone:406-407-4808
Mailing Address - Fax:
Practice Address - Street 1:3615 SPICER DR SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-7043
Practice Address - Country:US
Practice Address - Phone:541-967-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR64097OtherOREGON BOARD OF PHYSICAL THERAPY