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General NPI Number Information
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NPI Number | 1417934886
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Entity Type | Organization
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Legal Business Name | PT NORTHWEST LLC
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 685 36TH AVE NE
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City | SALEM
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State | OR
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Zip | 97301-0005
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Country | US
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Telephone | 503-371-8860
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Fax | 503-371-9299
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Provider Business Mailing Address
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Address Line | 685 36TH AVE NE
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City | SALEM
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State | OR
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Zip | 97301-4741
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Country | US
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Telephone | 503-540-8701
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Fax | 503-371-8772
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Authorized Official
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Title or Position | PRESIDENT GENERAL MANAGER
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Name | KENNEDY I HAWKINS
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Credential |
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Telephone | 503-540-8701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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