Healthcare Provider Details

I. General information

NPI: 1841824471
Provider Name (Legal Business Name): STARGAIT MEDFORD PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16420 SE MCGILLIVRAY BLVD STE 103-355
VANCOUVER WA
98683-3461
US

IV. Provider business mailing address

16420 SE MCGILLIVRAY BLVD STE 103-355
VANCOUVER WA
98683-3461
US

V. Phone/Fax

Practice location:
  • Phone: 541-292-4244
  • Fax: 855-840-8203
Mailing address:
  • Phone: 541-292-4244
  • Fax: 855-840-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE A WENTZEL
Title or Position: OWNER
Credential: PT
Phone: 541-292-4244