Individual
DAN WAKEFIELD HIRTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
211 DAKOTA ST, SUTHERLIN, OR 97479-9908
(541) 315-2851
(541) 315-2853
Mailing address
211 DAKOTA ST, SUTHERLIN, OR 97479-9908
(541) 315-2851
(541) 315-2853
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2521
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
295705
—
OR
01
—
650012922
RR MEDICARE
OR
Enumeration date
12/07/2005
Last updated
11/08/2016
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