Healthcare Provider Details

I. General information

NPI: 1811201247
Provider Name (Legal Business Name): RECLAIM PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 WILLAGILLESPIE RD STE 1
EUGENE OR
97401-6711
US

IV. Provider business mailing address

1144 WILLAGILLESPIE RD SUITE 1
EUGENE OR
97401-6729
US

V. Phone/Fax

Practice location:
  • Phone: 541-636-4471
  • Fax: 541-357-4992
Mailing address:
  • Phone: 541-636-4471
  • Fax: 541-357-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5603
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK OUELLETTE
Title or Position: OWNER
Credential: PT
Phone: 541-636-4471