Healthcare Provider Details

I. General information

NPI: 1083646806
Provider Name (Legal Business Name): OREGON SPINE & PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 MELTON ROAD
CRESWELL OR
97426
US

IV. Provider business mailing address

1300 W SAM HOUSTON PKWY S SUITE 300
HOUSTON TX
77042-2447
US

V. Phone/Fax

Practice location:
  • Phone: 541-895-5913
  • Fax: 541-895-5941
Mailing address:
  • Phone: 713-297-7000
  • Fax: 713-297-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
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:

VIII. Authorized Official

Name: JANNA P. KING
Title or Position: VP/AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7000