Healthcare Provider Details

I. General information

NPI: 1932503000
Provider Name (Legal Business Name): K2 PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 COBURG RD B2
EUGENE OR
97401-7486
US

IV. Provider business mailing address

2295 COBURG RD B2
EUGENE OR
97401-7486
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-7594
  • Fax: 541-505-7661
Mailing address:
  • Phone: 541-505-7594
  • Fax: 541-505-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5157
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. KATIE MCLAUGHLIN
Title or Position: OWNER
Credential: MSPT
Phone: 541-505-7594