Healthcare Provider Details

I. General information

NPI: 1538224084
Provider Name (Legal Business Name): MCKENZIE CROSSING ORTHOPEDIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S 52ND PL
SPRINGFIELD OR
97478
US

IV. Provider business mailing address

145 S 52ND PL
SPRINGFIELD OR
97478-6210
US

V. Phone/Fax

Practice location:
  • Phone: 541-988-3337
  • Fax: 541-988-3299
Mailing address:
  • Phone: 541-988-3337
  • Fax: 541-988-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN K. GESIK
Title or Position: OWNER
Credential: P.T.
Phone: 541-988-3337