Healthcare Provider Details

I. General information

NPI: 1144996752
Provider Name (Legal Business Name): SISKIYOU PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 A ST
ASHLAND OR
97520-2070
US

IV. Provider business mailing address

665 A ST
ASHLAND OR
97520-2070
US

V. Phone/Fax

Practice location:
  • Phone: 970-948-0244
  • Fax: 503-820-2690
Mailing address:
  • Phone: 970-948-0244
  • Fax: 503-820-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL QUINN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 970-948-0244