Healthcare Provider Details

I. General information

NPI: 1659713063
Provider Name (Legal Business Name): MEREDITH ALISON WAMPLER-KUHN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 NE PALMER DR
BEND OR
97701-7683
US

IV. Provider business mailing address

3332 NE PALMER DR
BEND OR
97701-7683
US

V. Phone/Fax

Practice location:
  • Phone: 541-948-5633
  • Fax:
Mailing address:
  • Phone: 541-948-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60224
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: