Basic Information
| Provider Information | |||||||||
| NPI: | 1447331681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1888 | ||||||||
| Address2: | |||||||||
| City: | LA PINE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977391888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415366122 | ||||||||
| FaxNumber: | 5415366123 | ||||||||
| Practice Location | |||||||||
| Address1: | 51681 HUNTINGTON RD | ||||||||
| Address2: | |||||||||
| City: | LA PINE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977399626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415366122 | ||||||||
| FaxNumber: | 5415366123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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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 | 60393 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 60393 | 01 | OR | OREGON PHYSICAL THERAPY LICENSE | OTHER |