Individual
SHANE EMERSON BAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2728 PHEASANT BLVD, SUITE 100, SPRINGFIELD, OR 97477-7509
(541) 736-8870
(541) 736-8860
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60057
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500655109
—
OR
01
—
P01220789
RR MEDICARE
OR
Enumeration date
02/08/2013
Last updated
11/14/2013
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