Basic Information
| Provider Information | |||||||||
| NPI: | 1619644002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOBLADO | ||||||||
| FirstName: | AUGUSTINE | ||||||||
| MiddleName: | BERNARD CANTWELL | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10690 NE CORNELL RD STE 314 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971249224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032169760 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10690 NE CORNELL RD STE 314 | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971249224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032169760 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2021 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 64158 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.