Provider Demographics
NPI:1063573970
Name:SURFACE, JAMES D (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:SURFACE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:14314 SW ALLEN BLVD #214
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4409
Mailing Address - Country:US
Mailing Address - Phone:503-649-2575
Mailing Address - Fax:503-649-4744
Practice Address - Street 1:1909 MOUNTAIN VIEW LN #300
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:503-359-3979
Practice Address - Fax:503-648-2441
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR1627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000CFCTMedicare ID - Type Unspecified
0000CFCJRMedicare ID - Type Unspecified