Healthcare Provider Details

I. General information

NPI: 1578778437
Provider Name (Legal Business Name): OREGON SPINE & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COUNTRY CLUB PKWY SUITE B
EUGENE OR
97401-6036
US

IV. Provider business mailing address

560 COUNTRY CLUB PKWY SUITE B
EUGENE OR
97401-6036
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5139
  • Fax: 541-683-5783
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTOPHER CORRIGAN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000