Shane Emerson Baze, P.T.
Individual provider Active NPI Physical Therapist · Springfield, OR
NPI 1629317706 · NPPES record last updated Nov 14, 2013
Key facts
- NPI
- 1629317706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 60057 (OR)
- Practice address
- 2728 Pheasant Blvd
Suite 100
Springfield, OR 97477-7509 - Phone
- (541) 736-8870
- Fax
- (541) 736-8860
- NPI assigned
- Feb 8, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60057 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 60057 | OR | Yes |
Addresses
Primary practice location
2728 Pheasant Blvd
Suite 100
Springfield, OR 97477-7509
Mailing address
16083 SW Upper Boones Ferry Rd
Suite 300
Tigard, OR 97224-7736
Phone (800) 219-8835
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500655109 | Medicaid | OR | |
| P01220789 | Other | OR | RR MEDICARE |
Other providers in Springfield, OR
- Alex Christian Bauer
- Beth K Bauer
- Danielle Bauer
- Emily Anne Baughman
- Aimee Baur
- Mark Peter Beach I
- Elyse Magdalene Beachy
- Joseph Warren Beal
- Jage Joy Bechtle
- Amanda S Becker
All providers in Springfield, OR · Physical Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.