1477883841 NPI number — NORTHEAST OREGON PHYSICAL THERAPY

Table of content: (NPI 1477883841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477883841 NPI number — NORTHEAST OREGON PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST OREGON 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:
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:
1477883841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97827-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-963-9340
Provider Business Mailing Address Fax Number:
541-963-4562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SUNSET DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-963-9340
Provider Business Practice Location Address Fax Number:
541-963-4562
Provider Enumeration Date:
01/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-963-9340

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0557 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 838502000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com