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NPI Code Detail

MEDICARE: ERIC D.C. QUON PT

MEDICARE:   ERIC D.C. QUON  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist3037OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053340216
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC D.C. QUON PT
Provider Business Mailing Address
First Line : 1825 N WILLIAMS AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1864
Country : US
Telephone Number : 503-288-2615
Fax Number : 503-288-0339
Provider Business Practice Location Address
First Line : 1825 N WILLIAMS AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1864
Country : US
Telephone Number : 503-288-2615
Fax Number : 503-288-0339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2006
Last Update Date : 07/08/2007

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Directions to “ ERIC D.C. QUON PT” Practice Location

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