Healthcare Provider Details

I. General information

NPI: 1346218831
Provider Name (Legal Business Name): BRIAN DAVID EUBANKS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10466 SE MAIN ST
MILWAUKIE OR
97222-7509
US

IV. Provider business mailing address

101 S STATE ST SUITE 200G
LAKE OSWEGO OR
97034-3900
US

V. Phone/Fax

Practice location:
  • Phone: 503-353-9976
  • Fax: 503-353-9777
Mailing address:
  • Phone: 503-860-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4138
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: