MEDICARE: DAVID ALLEN DEPPELER 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
1	225100000X	Physical Therapist	2038	OR
2	225100000X	Physical Therapist	PT00006055	WA
3	225100000X	Physical Therapist	3793	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0182472	OTHER	OR	WASHINGTON L&I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649250796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN DEPPELER PT

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	STE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	4829 NE MARTIN LUTHER KING BLVD
Second Line	:	STE 101
City	:	PORTLAND
State	:	OR
Zip	:	97211-3351
Country	:	US
Telephone Number	:	503-283-8133
Fax Number	:	503-289-2312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/02/2012

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