Healthcare Provider Details

I. General information

NPI: 1073667218
Provider Name (Legal Business Name): OREGON NEUROSPORT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 IVY ST
JUNCTION CITY OR
97448-1636
US

IV. Provider business mailing address

PO BOX 275
JUNCTION CITY OR
97448-0275
US

V. Phone/Fax

Practice location:
  • Phone: 541-998-9988
  • Fax: 541-998-9987
Mailing address:
  • Phone: 541-998-9988
  • Fax: 541-998-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL HOWARD BAUM
Title or Position: PHYSICAL THERAPIST
Credential: BS, CFMT
Phone: 541-998-9988