Individual
RHETT FIELDSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
702 SW RAMSEY AVE, STE. 220, GRANTS PASS, OR 97527-5858
(541) 479-0765
(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
60579
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0327609
WA L&I
OR
05
—
500672686
—
OR
01
—
P01396207
RR MEDICARE PTAN
OR
Enumeration date
05/21/2014
Last updated
02/09/2015
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