Healthcare Provider Details

I. General information

NPI: 1750614749
Provider Name (Legal Business Name): TOTAL PERFORMANCE SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 NW 6TH ST
GRANTS PASS OR
97526-1255
US

IV. Provider business mailing address

PO BOX 774
GRANTS PASS OR
97528-0066
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-4010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MORGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-476-4010