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NPI Code Detail

MEDICARE: DAN WAKEFIELD HIRTLE PT

MEDICARE: DAN WAKEFIELD HIRTLE 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 Therapist2521OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2650012922OTHERORRR MEDICARE

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 : 1487639977
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAN WAKEFIELD HIRTLE PT
Provider Business Mailing Address
First Line : 211 DAKOTA ST
Second Line :
City : SUTHERLIN
State : OR
Zip : 97479-9908
Country : US
Telephone Number : 541-315-2851
Fax Number : 541-315-2853
Provider Business Practice Location Address
First Line : 211 DAKOTA ST
Second Line :
City : SUTHERLIN
State : OR
Zip : 97479-9908
Country : US
Telephone Number : 541-315-2851
Fax Number : 541-315-2853
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 11/08/2016

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Directions to “ DAN WAKEFIELD HIRTLE PT” Practice Location

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