Provider Demographics
NPI:1750365789
Name:SPANIOL TURNER, JUDY ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELIZABETH
Last Name:SPANIOL TURNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ELIZABETH
Other - Last Name:SPANIOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:17700 SE MILL PLAIN
Practice Address - Street 2:STE 150 TAI - VANCOUVER PHYSICAL THERAPY
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5518
Practice Address - Country:US
Practice Address - Phone:360-514-9383
Practice Address - Fax:360-514-0193
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005205225100000X
OR1499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8371080Medicaid
ORR134948Medicare PIN
WAAB39293Medicare ID - Type Unspecified
ORR155509Medicare PIN