Provider Demographics
NPI:1215117734
Name:NAFZIGER, DAN RAY (LPTPC)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:RAY
Last Name:NAFZIGER
Suffix:
Gender:M
Credentials:LPTPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SW WESTGATE DR
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2409
Mailing Address - Country:US
Mailing Address - Phone:503-297-3003
Mailing Address - Fax:503-297-9414
Practice Address - Street 1:5415 SW WESTGATE DR
Practice Address - Street 2:SUITE LL3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2409
Practice Address - Country:US
Practice Address - Phone:503-297-3003
Practice Address - Fax:503-297-9414
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000CFBVJOtherMEDICARE ID
OR000898Medicaid