Organization Name: | SOUTHWEST PHYSICAL THERAPY |
NPI Number: | 1669695854 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CORY DORLAND (BUSINESS MANAGER) |
Mailing Address: | 913 11th St Se Suite 1 Bandon |
State: | OR US |
Postal Code: | 974119168 |
Phone Number: | 5413474314 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 09/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation |
Taxonomy Definition: |