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General NPI Number Information
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NPI Number | 1538224084
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Entity Type | Organization
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Legal Business Name | MCKENZIE CROSSING ORTHOPEDIC PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 145 S 52ND PL
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City | SPRINGFIELD
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State | OR
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Zip | 97478
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Country | US
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Telephone | 541-988-3337
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Fax | 541-988-3299
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Provider Business Mailing Address
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Address Line | 145 S 52ND PL
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City | SPRINGFIELD
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State | OR
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Zip | 97478-6210
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Country | US
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Telephone | 541-988-3337
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Fax | 541-988-3299
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN K. GESIK
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Credential | P.T.
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Telephone | 541-988-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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