Healthcare Provider Details

I. General information

NPI: 1225200595
Provider Name (Legal Business Name): REHABILITATION ASSOCIATES NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NW PROFESSIONAL DR STE 100
CORVALLIS OR
97330-3891
US

IV. Provider business mailing address

2211 NW PROFESSIONAL DR STE 100
CORVALLIS OR
97330-3891
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-7269
  • Fax: 541-757-7465
Mailing address:
  • Phone: 541-757-7269
  • Fax: 541-757-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSAN GORTHEY BOTTOMLEY
Title or Position: OWNER
Credential:
Phone: 541-757-7269