Healthcare Provider Details

I. General information

NPI: 1174890479
Provider Name (Legal Business Name): CAPITOL PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MCNARY ESTATES DR N
KEIZER OR
97303-7459
US

IV. Provider business mailing address

495 STATE ST FL 6
SALEM OR
97301-3757
US

V. Phone/Fax

Practice location:
  • Phone: 503-400-7717
  • Fax: 503-400-6022
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J WILLIAMS
Title or Position: OWNER/PRESIDENT/THERAPIST
Credential: PT
Phone: 503-364-5313