Provider Demographics
NPI:1649537945
Name:BORDAN, DOUGLAS GRANT (PT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:GRANT
Last Name:BORDAN
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 1:568 NE SAVANNAH DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4866
Mailing Address - Country:US
Mailing Address - Phone:541-728-1562
Mailing Address - Fax:
Practice Address - Street 1:568 NE SAVANNAH DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4866
Practice Address - Country:US
Practice Address - Phone:541-728-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist