Healthcare Provider Details

I. General information

NPI: 1790194793
Provider Name (Legal Business Name): SEAN DORMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 E BROADWAY
EUGENE OR
97401
US

IV. Provider business mailing address

244 E BROADWAY
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-338-7088
  • Fax: 541-345-3559
Mailing address:
  • Phone: 541-338-7088
  • Fax: 541-345-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

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: