Provider Demographics
NPI:1881854115
Name:SHRUM, BOBBI JO (PTA)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:SHRUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:JO
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-1007
Mailing Address - Country:US
Mailing Address - Phone:503-838-0001
Mailing Address - Fax:503-838-7826
Practice Address - Street 1:1525 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-1007
Practice Address - Country:US
Practice Address - Phone:503-838-0001
Practice Address - Fax:503-838-7826
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7856225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant