Healthcare Provider Details

I. General information

NPI: 1851864292
Provider Name (Legal Business Name): OREGON SPORTSCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 NW HIGHWAY 99
CORVALLIS OR
97330-9484
US

IV. Provider business mailing address

3201 NW SHOOTING STAR DR
CORVALLIS OR
97330-3465
US

V. Phone/Fax

Practice location:
  • Phone: 541-207-3626
  • Fax:
Mailing address:
  • Phone: 503-528-6864
  • Fax:

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: KYLE LARKIN
Title or Position: OWNER
Credential:
Phone: 503-528-6864