Healthcare Provider Details

I. General information

NPI: 1881746220
Provider Name (Legal Business Name): DOWNTOWN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 WILLAMETTE ST
EUGENE OR
97401-3112
US

IV. Provider business mailing address

999 WILLAMETTE ST
EUGENE OR
97401-3112
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-9314
  • Fax: 888-972-6544
Mailing address:
  • Phone: 541-687-9314
  • Fax: 888-972-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1991
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier028310
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: KEVIN DONALD REILLY
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 541-687-9314