Healthcare Provider Details

I. General information

NPI: 1730902651
Provider Name (Legal Business Name): PRO PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NE MILL STREET
GRANTS PASS OR
97527-6309
US

IV. Provider business mailing address

1462 DARNEILLE LN
GRANTS PASS OR
97527-6309
US

V. Phone/Fax

Practice location:
  • Phone: 541-218-5309
  • Fax:
Mailing address:
  • Phone: 541-218-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
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: KAYLA NAMIKO LOFFER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 541-218-5309