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General NPI Number Information
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NPI Number | 1598539017
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Entity Type | Organization
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Legal Business Name | LEBANON PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 1195 S MAIN ST
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City | LEBANON
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State | OR
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Zip | 97355-3217
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Country | US
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Telephone | 541-401-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 S MAIN ST
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City | LEBANON
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State | OR
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Zip | 97355-3217
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Country | US
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Telephone | 541-401-6500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAN JENKINS
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Credential | DPT
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Telephone | 650-235-0545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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