Basic Information
| Provider Information | |||||||||
| NPI: | 1528001690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11481 SW HALL BV | ||||||||
| Address2: | STE 201 THERAPEUTIC ASSOCIATES INC | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5034431402 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NE NEFF RD | ||||||||
| Address2: | SUITE 202 TAI-CENTRAL OREGON BEND | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977014281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413887738 | ||||||||
| FaxNumber: | 5413120121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 12/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4396 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 6252 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 3292592401 | UT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.