1831585033 NPI number — ADVANTAGE PHYSICAL THERAPY AND HEALTH EDUCATION CENTER, LLC

Table of content: (NPI 1831585033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831585033 NPI number — ADVANTAGE PHYSICAL THERAPY AND HEALTH EDUCATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANTAGE PHYSICAL THERAPY AND HEALTH EDUCATION CENTER, LLC
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:
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NPI Number Information

NPI Number:
1831585033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEHALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97131-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
278 ROWE RD
Provider Second Line Business Practice Location Address:
STE 224
Provider Business Practice Location Address City Name:
WHEELER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97147-0035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-368-4978
Provider Business Practice Location Address Fax Number:
503-368-4979
Provider Enumeration Date:
04/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MASSIE
Authorized Official First Name:
RAECHEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
503-368-4978

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2437 , 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)





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