Provider Demographics
NPI:1588171706
Name:HAVENS, TONY (LMT)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:HAVENS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 NE GREENWOOD AVE # A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4607
Mailing Address - Country:US
Mailing Address - Phone:541-241-3135
Mailing Address - Fax:
Practice Address - Street 1:461 NE GREENWOOD AVE # A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4607
Practice Address - Country:US
Practice Address - Phone:541-241-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225700000X
ORACC222417171100000X
OR125472081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine