Healthcare Provider Details

I. General information

NPI: 1770884652
Provider Name (Legal Business Name): STASZAK PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E 11TH AVE STE 3A
EUGENE OR
97401-3601
US

IV. Provider business mailing address

488 E 11TH AVE
EUGENE OR
97401-3601
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-8180
  • Fax: 541-505-7134
Mailing address:
  • Phone: 541-505-8180
  • Fax: 541-505-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE STASZAK
Title or Position: OWNER
Credential:
Phone: 541-505-8180