Healthcare Provider Details

I. General information

NPI: 1972635597
Provider Name (Legal Business Name): REORDAN PHYSCIAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N 5TH ST
JACKSONVILLE OR
97530-9659
US

IV. Provider business mailing address

635 N 5TH ST
JACKSONVILLE OR
97530-9659
US

V. Phone/Fax

Practice location:
  • Phone: 541-664-5151
  • Fax:
Mailing address:
  • Phone: 541-899-8179
  • Fax: 541-899-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DONALD REORDAN
Title or Position: OWNER
Credential:
Phone: 541-664-5151