Healthcare Provider Details

I. General information

NPI: 1689228686
Provider Name (Legal Business Name): GROUND WORK PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 NE DIVISION ST STE 1
BEND OR
97703-3570
US

IV. Provider business mailing address

2330 NE DIVISION ST STE 1
BEND OR
97703-3570
US

V. Phone/Fax

Practice location:
  • Phone: 928-607-9045
  • Fax: 541-508-7839
Mailing address:
  • Phone:
  • Fax: 541-508-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KATHARINE MAGUIRE
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 928-607-9045