Provider Demographics
NPI:1720286610
Name:AINSWORTH, MARCUS A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:AINSWORTH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 NE CONNERS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6761
Mailing Address - Country:US
Mailing Address - Phone:541-382-5500
Mailing Address - Fax:541-389-5669
Practice Address - Street 1:2546 NE CONNERS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6761
Practice Address - Country:US
Practice Address - Phone:541-382-5500
Practice Address - Fax:541-389-5669
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6241225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500624815Medicaid
OR500624815Medicaid
ORR154820Medicare PIN