1295485084 NPI number — DARLING PHYSICAL THERAPY

Table of content: (NPI 1295485084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295485084 NPI number — DARLING PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARLING PHYSICAL THERAPY
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:
Provider Other Organization Name Type Code:
6
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:
1295485084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 WOODLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97477-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-225-5611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2728 PHEASANT BLVD
Provider Second Line Business Practice Location Address:
WELLNESS CENTER
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-972-3036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DARLING
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official Telephone Number:
541-972-3036

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1295485084 . This is a "NIP TYPE 2" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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