Healthcare Provider Details

I. General information

NPI: 1013949239
Provider Name (Legal Business Name): OMNIS OMNIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NW GREENWOOD AVE
REDMOND OR
97756-1531
US

IV. Provider business mailing address

450 NW GREENWOOD AVE
REDMOND OR
97756-1531
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0410
  • Fax: 541-923-7393
Mailing address:
  • Phone: 541-923-0410
  • Fax: 541-923-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11195654
License Number StateOR

VIII. Authorized Official

Name: SUZANNE KNOX
Title or Position: SECRETARY
Credential: PT
Phone: 541-923-0410