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General NPI Number Information
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NPI Number | 1558704221
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Entity Type | Organization
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Legal Business Name | REJUVENATION THERAPY PAIN CLINIC, LLP
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1180 CROSS ST SE
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City | SALEM
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State | OR
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Zip | 97302-2924
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Country | US
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Telephone | 503-999-8464
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Fax | 503-991-5355
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Provider Business Mailing Address
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Address Line | 1180 CROSS ST SE
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City | SALEM
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State | OR
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Zip | 97302-2924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MINH NGUYEN
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Credential |
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Telephone | 503-851-2453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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