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General NPI Number Information
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NPI Number | 1669695854
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 913 11TH ST SE SUITE 1
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City | BANDON
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State | OR
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Zip | 97411-9168
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Country | US
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Telephone | 541-347-4314
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Fax |
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Provider Business Mailing Address
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Address Line | 913 11TH ST SE SUITE 1
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City | BANDON
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State | OR
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Zip | 97411-9168
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Country | US
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Telephone | 541-347-4314
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. CORY DORLAND
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Credential |
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Telephone | 541-269-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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