Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 225100000X | Physical Therapist | 64083 | OR |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1346814936 |
---|---|
Provider Name | Joel Thakkar |
First Address | Eugene, OR 97401-6711 |
Second Address | Eugene, OR 97401-6711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2021 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64083 | OREGON BOARD OF PHYSICAL THERAPY (01) | OR |