Healthcare Provider Details

I. General information

NPI: 1114347549
Provider Name (Legal Business Name): STEPPING OUT PHYSICAL THERAPY AND CUSTOM FEET ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3498 NW DEER RUN ST
CORVALLIS OR
97330-3111
US

IV. Provider business mailing address

3498 NW DEER RUN ST
CORVALLIS OR
97330-3111
US

V. Phone/Fax

Practice location:
  • Phone: 541-908-1943
  • Fax: 541-757-7907
Mailing address:
  • Phone: 541-908-1943
  • Fax: 541-757-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA SHELTON
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 541-908-1943