Provider Demographics
NPI:1740356500
Name:AARESTAD, PATRICIA ANN (RPT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:AARESTAD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0237
Mailing Address - Country:US
Mailing Address - Phone:541-881-1507
Mailing Address - Fax:541-889-0417
Practice Address - Street 1:198 S OREGON ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2808
Practice Address - Country:US
Practice Address - Phone:541-881-1507
Practice Address - Fax:541-889-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR206367Medicaid
OR004513000OtherBLUE CROSS BLUE SHIELD
ID805760700Medicaid
ID805760700Medicaid