Healthcare Provider Details

I. General information

NPI: 1407802101
Provider Name (Legal Business Name): GREGORY ZADOW INC. P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N. LOCUST STREET
SISTERS OR
97759
US

IV. Provider business mailing address

PO BOX 1911
SISTERS OR
97759-1911
US

V. Phone/Fax

Practice location:
  • Phone: 541-549-3534
  • Fax: 541-549-1272
Mailing address:
  • Phone: 541-549-3534
  • Fax: 541-549-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4090
License Number StateOR

VIII. Authorized Official

Name: CAROL DENISE STATTON
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 541-299-0294