MEDICARE: APEX PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	5164	OR

General Provider Information

NPI Number	:	1164553384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 2439
Second Line	:
City	:	REDMOND
State	:	OR
Zip	:	97756-0551
Country	:	US
Telephone Number	:	541-923-7794
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 SW 5TH ST
Second Line	:
City	:	MADRAS
State	:	OR
Zip	:	97741-1341
Country	:	US
Telephone Number	:	541-475-1218
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. BROCK P MONGER
Credential	:	DPT, ATC, CSCS
Telephone Number	:	541-923-7794

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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Directions to “APEX PHYSICAL THERAPY LLC ” Practice Location

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