Organization Name: | OREGON NEUROSPORT PHYSICAL THERAPY |
NPI Number: | 1073667218 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL HOWARD BAUM (PHYSICAL THERAPIST) |
Mailing Address: | 680 Ivy St Junction City |
State: | OR US |
Postal Code: | 974481636 |
Phone Number: | 5419989988 |
Fax Number: | 5419989987 |
NPI Enumeration Date: | 01/23/2007 |
NPI Last Update Date: | 08/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 2756 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |