Basic Information
Provider Information
NPI: 1801426242
EntityType: 2
ReplacementNPI:  
OrganizationName: THERAPEUTIC ASSOCIATES, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: TAI - DOWNTOWN EUGENE PHYSICAL THERAPY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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Mailing Information
Address1: 16083 SW UPPER BOONES FERRY RD
Address2: SUITE 300
City: TIGARD
State: OR
PostalCode: 972247736
CountryCode: US
TelephoneNumber: 8002198835
FaxNumber: 5036399699
Practice Location
Address1: 760 CHARNELTON ST.
Address2: SUITE 760
City: EUGENE
State: OR
PostalCode: 97401
CountryCode: US
TelephoneNumber: 5416875958
FaxNumber: 5416875882
Other Information
ProviderEnumerationDate: 01/24/2020
LastUpdateDate: 02/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HAMILTON
AuthorizedOfficialFirstName: MELISSA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR PAYER PROVIDER RELATIONS
AuthorizedOfficialTelephone: 8002198835
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 02/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y193400000X SINGLE SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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