| Organization Name: | WILLAMETTE SPINE CENTER PHYSICAL THERAPY & REHABILITATION, LLC |
| NPI Number: | 1063548329 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL CHARLES GIBBONS (OWNER AND PHYSICAL THERAPIST) |
| Mailing Address: | 2480 Liberty St Ne Ste 140 Salem |
| State: | OR US |
| Postal Code: | 973036781 |
| Phone Number: | 5037633525 |
| Fax Number: | 5037633526 |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 07/31/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |