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General NPI Number Information
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NPI Number | 1558495762
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Entity Type | Organization
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Legal Business Name | PERFORMANCE ZONE SPORTS AND ORTHOPEDIC PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 2138 LANCASTER DR NE SUITE 103
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City | SALEM
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State | OR
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Zip | 97305-1227
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Country | US
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Telephone | 503-371-4800
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Fax | 503-371-4801
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Provider Business Mailing Address
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Address Line | 2138 LANCASTER DR NE SUITE 103
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City | SALEM
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State | OR
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Zip | 97305-1227
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Country | US
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Telephone | 503-371-4800
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Fax | 503-371-4801
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MR. DARYL LEON IVINS
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Credential | PT
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Telephone | 503-371-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3584
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License Number State | OR
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