Provider Demographics
NPI:1235324948
Name:BASTIAN PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:BASTIAN PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LMT
Authorized Official - Phone:503-697-0542
Mailing Address - Street 1:870 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2312
Mailing Address - Country:US
Mailing Address - Phone:503-697-0542
Mailing Address - Fax:503-697-4895
Practice Address - Street 1:870 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2312
Practice Address - Country:US
Practice Address - Phone:503-697-0542
Practice Address - Fax:503-697-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR115802Medicare UPIN