Individual
RICHARD H SHORTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
805 SW INDUSTRIAL WAY, SUITE 3, BEND, OR 97702-1118
(541) 585-2530
(541) 585-2536
Mailing address
974 SW VETERANS WAY, SUITE 4, REDMOND, OR 97756-2564
(541) 504-2350
(541) 504-2354
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4990
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269866
—
OR
Enumeration date
03/29/2007
Last updated
07/09/2007
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