Individual
MR. THAD G HARLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.P.T.
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504
(970) 361-0008
Mailing address
3126 ALAMEDA ST UNIT 306, MEDFORD, OR 97504-8678
(709) 361-0008
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8350
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840999425
TAX ID
CO
01
—
840999425011
ROCKY MOUNTAIN HMO NUMBER
CO
01
—
P00376779
MEDICARE, RAILROAD
CO
Enumeration date
08/31/2006
Last updated
09/13/2018
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