Provider Demographics
NPI:1124060835
Name:SPRAGUE, ANN MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 PATTON LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9135
Mailing Address - Country:US
Mailing Address - Phone:541-941-5170
Mailing Address - Fax:541-878-8111
Practice Address - Street 1:21850 HIGHWAY 62 STE 203
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-8715
Practice Address - Country:US
Practice Address - Phone:541-941-5170
Practice Address - Fax:541-878-8111
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
836420009OtherBC
ORR165938.OtherMEDICARE ID UNSPECIFIED
J691808OtherPACIFIC SOURCE