MEDICARE: BENCHMARK PHYSICAL THERAPY OF OREGON LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1194231159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCHMARK PHYSICAL THERAPY OF OREGON LLC

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-965-6400
Fax Number	:

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-2313

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	05/07/2018

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Directions to “BENCHMARK PHYSICAL THERAPY OF OREGON LLC ” Practice Location

Language	Start Address	Practice Location

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