Individual
ERIC C VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
425 N MAIN ST, PRINEVILLE, OR 97754
(541) 416-7476
(541) 416-7478
Mailing address
805 SW INDUSTRIAL WAY, SUITE 3, BEND, OR 97702-1093
(541) 585-2529
(541) 585-2535
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1234
AK
225100000X
Physical Therapist
Primary
4645
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159333011
BLUE CROSS BLUE SHIELD
OR
05
—
229143
—
OR
Enumeration date
01/29/2007
Last updated
10/17/2008
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