Provider Demographics
NPI:1124089537
Name:NANCE, JOSEPH D (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:NANCE
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR60503225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669801Medicaid
ORR174681Medicare PIN
WAGAB37236Medicare PIN