| Organization Name: | CORE PHYSICAL THERAPY AND SPINE LLC |
| NPI Number: | 1003149485 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER BRASSFIELD (CO-OWNER/PHYSICAL THERAPIST) |
| Mailing Address: | 336 Sw Cyber Dr Ste 107 Bend |
| State: | OR US |
| Postal Code: | 977021682 |
| Phone Number: | 5413896595 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2009 |
| NPI Last Update Date: | 01/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 1543 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |