Healthcare Provider Details

I. General information

NPI: 1639359524
Provider Name (Legal Business Name): DEBORAH L BATES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH L ANDERSON

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 PHEASANT BLVD SUITE 100
SPRINGFIELD OR
97477-7509
US

IV. Provider business mailing address

PO BOX 34569
SEATTLE WA
98124-1569
US

V. Phone/Fax

Practice location:
  • Phone: 541-736-8870
  • Fax: 541-736-8860
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5116
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: