Healthcare Provider Details

I. General information

NPI: 1164497111
Provider Name (Legal Business Name): CHEHALEM PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N EVEREST ST
NEWBERG OR
97132-2102
US

IV. Provider business mailing address

118 N EVEREST ST
NEWBERG OR
97132-2102
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-8952
  • Fax: 503-537-2027
Mailing address:
  • Phone: 503-538-8952
  • Fax: 503-537-2027

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 Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN ELIZABETH SEVEREID
Title or Position: OWNER / CFO
Credential: DPT
Phone: 503-538-8952