Basic Information
| Provider Information | |||||||||
| NPI: | 1629052576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWD | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | SHULMAN | ||||||||
| OtherFirstName: | DAVID | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11481 SW HALL BV STE 201 | ||||||||
| Address2: | THERAPEUTIC ASSOCIATES INC | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5034431402 | ||||||||
| Practice Location | |||||||||
| Address1: | 4242 COMMERCE SUITE A | ||||||||
| Address2: | TAI WEST EUGENE PHYSICAL THERAPY | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974025418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414849632 | ||||||||
| FaxNumber: | 5414847466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4923 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 28145 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 277958 | 05 | OR | MEDICAID |