Provider Demographics
NPI:1942275789
Name:ENDTER, NANCY E (PT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:ENDTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:BERGFALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:11481 SW HALL BV
Mailing Address - Street 2:STE 201 THERAPEUTIC ASSOCIATES INC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8403
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-443-1402
Practice Address - Street 1:61615 ATHLETIC CLUB DR
Practice Address - Street 2:TAI CENTRAL OREGON ATHLETIC CLUB
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-382-7890
Practice Address - Fax:541-382-7498
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5039225100000X
CA25786225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR386526Medicare ID - Type Unspecified