Provider Demographics
NPI:1194984377
Name:STURZINGER, ERNEST JONATHAN (DPT)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:JONATHAN
Last Name:STURZINGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NE VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-3827
Mailing Address - Country:US
Mailing Address - Phone:503-489-6250
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:1001 MOLALLA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3788
Practice Address - Country:US
Practice Address - Phone:503-607-0047
Practice Address - Fax:503-607-0051
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR114519Medicare PIN
ORR142645Medicare PIN
ORR114778Medicare PIN
ORR142642Medicare PIN
ORR130647Medicare PIN
ORR114556Medicare PIN
ORR143332Medicare PIN
ORR142155Medicare PIN