Healthcare Provider Details

I. General information

NPI: 1194095232
Provider Name (Legal Business Name): ACHIEVE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 NW MULHOLLAND DR. #1
ROSEBURG OR
97470-1978
US

IV. Provider business mailing address

1931 NW MULHOLLAND DR. #1
ROSEBURG OR
97470-1978
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-5795
  • Fax: 541-672-5796
Mailing address:
  • Phone: 541-672-5795
  • Fax: 541-672-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER M GIBBS
Title or Position: OWNER
Credential: MPT
Phone: 541-672-5795