Healthcare Provider Details

I. General information

NPI: 1003058363
Provider Name (Legal Business Name): ALPINE PHYSICAL THERAPY AND WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 SW CYBER DR SUITE 107
BEND OR
97702-1683
US

IV. Provider business mailing address

336 SW CYBER DR STE 107
BEND OR
97702-1682
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-5500
  • Fax: 541-389-5669
Mailing address:
  • Phone: 541-382-5500
  • Fax: 541-389-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500669493
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: SCOTT B WEBER
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 541-382-5500