Provider Demographics
NPI:1316141401
Name:PRICE, CURTIS VAUGHN (MSPT)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:VAUGHN
Last Name:PRICE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5834
Mailing Address - Country:US
Mailing Address - Phone:541-391-4712
Mailing Address - Fax:541-391-4713
Practice Address - Street 1:4880 GRANGE RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5834
Practice Address - Country:US
Practice Address - Phone:541-391-4712
Practice Address - Fax:541-391-4713
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR161868Medicare PIN
ORR161869Medicare PIN