Provider Demographics
NPI:1952526717
Name:NANCY DEAL-WHITACRE PT
Entity Type:Organization
Organization Name:NANCY DEAL-WHITACRE PT
Other - Org Name:INDEPENDENT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEAL-WHITACRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-485-1154
Mailing Address - Street 1:1166 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4616
Mailing Address - Country:US
Mailing Address - Phone:541-485-1154
Mailing Address - Fax:541-485-8909
Practice Address - Street 1:1166 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4616
Practice Address - Country:US
Practice Address - Phone:541-485-1154
Practice Address - Fax:541-485-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0722261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109593Medicare ID - Type UnspecifiedCLINIC