Healthcare Provider Details

I. General information

NPI: 1841455813
Provider Name (Legal Business Name): BROOKE BEDINGFIELD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE WINGER DPT

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 COBURG ROAD #5
EUGENE OR
97401
US

IV. Provider business mailing address

1310 COBURG ROAD #5
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-7532
  • Fax: 541-345-6692
Mailing address:
  • Phone: 541-345-7532
  • Fax: 541-345-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5722
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier845868007
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerBCBS
# 2
IdentifierP00677004
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRRMC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: