Healthcare Provider Details

I. General information

NPI: 1194833756
Provider Name (Legal Business Name): CAPITOL PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 MEDICAL CENTER DR NE
SALEM OR
97301-2752
US

IV. Provider business mailing address

410 MILL ST SE # 1045
SALEM OR
97301-3601
US

V. Phone/Fax

Practice location:
  • Phone: 503-364-5313
  • Fax: 503-364-5296
Mailing address:
  • Phone: 503-364-5313
  • Fax: 503-364-5296

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, THERAPIST
Credential: P.T.
Phone: 503-364-5313