Basic Information
| Provider Information | |||||||||
| NPI: | 1891083705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAFARI | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | HOOMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15250 SW TEAL BLVD | ||||||||
| Address2: | APT. B | ||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970077628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034593387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1166 E 28TH AVE | ||||||||
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| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974031615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413450534 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2011 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 8301 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.