Healthcare Provider Details

I. General information

NPI: 1992975650
Provider Name (Legal Business Name): WOMENS HEALTH PHYSICAL THERAPY OF EUGENE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2008
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W BROADWAY
EUGENE OR
97401-2869
US

IV. Provider business mailing address

395 W BROADWAY
EUGENE OR
97401-2869
US

V. Phone/Fax

Practice location:
  • Phone: 541-515-6215
  • Fax: 541-515-6216
Mailing address:
  • Phone: 541-515-6215
  • Fax: 541-515-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3693
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. SHANNON MARIE FORRESTALL
Title or Position: PARTNER/PHYSICAL THERAPIST
Credential: PT
Phone: 503-551-1099