Provider Demographics
NPI:1780649673
Name:GIRARD, DUSTIN EARL (AT,C)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:EARL
Last Name:GIRARD
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 PEARL ST STE A
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2742
Mailing Address - Country:US
Mailing Address - Phone:541-687-9050
Mailing Address - Fax:
Practice Address - Street 1:970 PEARL ST STE A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2742
Practice Address - Country:US
Practice Address - Phone:541-687-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101305022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty