1538369723 NPI number — WHD CORPORATION

Table of content: (NPI 1538369723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538369723 NPI number — WHD CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHD CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE JUNGLE GYM PEDIATRIC THERAPY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538369723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KLAMATH FALLS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97601-0075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-882-1540
Provider Business Mailing Address Fax Number:
541-882-2583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-6114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-887-7362
Provider Business Practice Location Address Fax Number:
541-273-2486
Provider Enumeration Date:
07/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIXON
Authorized Official First Name:
DENA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
541-887-7362

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  2063 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , with the licence number: 242685 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 12514 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4720537 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182019 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".