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General NPI Number Information
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NPI Number | 1306230917
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 1650 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2170
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Country | US
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Telephone | 541-269-7212
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Fax | 541-267-5260
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Provider Business Mailing Address
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Address Line | 1650 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2170
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Country | US
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Telephone | 541-269-7212
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Fax | 541-267-5260
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. CORY D DORLAND
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Credential |
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Telephone | 541-269-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | 336600
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License Number State | OR
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