Basic Information
| Provider Information | |||||||||
| NPI: | 1255846309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELFIN | ||||||||
| FirstName: | CHESTER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3270 LIBERTY RD. S. | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033710779 | ||||||||
| FaxNumber: | 5033710886 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 TAGGART DR NW STE 150 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973044149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033636770 | ||||||||
| FaxNumber: | 5033634789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2017 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6109 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 500737075 | 05 | OR | MEDICAID |