Provider Demographics
NPI:1184600298
Name:QUATRE, TANNUS ERIK (PT)
Entity type:Individual
Prefix:
First Name:TANNUS
Middle Name:ERIK
Last Name:QUATRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6173
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6173
Mailing Address - Country:US
Mailing Address - Phone:541-550-7291
Mailing Address - Fax:541-550-7356
Practice Address - Street 1:1465 SW KNOLL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3261
Practice Address - Country:US
Practice Address - Phone:541-550-7291
Practice Address - Fax:541-550-7356
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4381225100000X
CA24730225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181650Medicaid
OR386526Medicare ID - Type Unspecified