Healthcare Provider Details

I. General information

NPI: 1750393385
Provider Name (Legal Business Name): CENTRAL COAST PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NW 3RD ST
NEWPORT OR
97365-3640
US

IV. Provider business mailing address

135 NW 3RD ST
NEWPORT OR
97365-3640
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-2818
  • Fax: 541-265-3274
Mailing address:
  • Phone: 541-265-2818
  • Fax: 541-265-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier228867
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: DEBBIE HILLMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-265-2818