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General NPI Number Information
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NPI Number | 1851864292
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Entity Type | Organization
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Legal Business Name | OREGON SPORTSCARE LLC
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 5520 NW HIGHWAY 99
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City | CORVALLIS
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State | OR
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Zip | 97330-9484
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Country | US
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Telephone | 541-207-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 NW SHOOTING STAR DR
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City | CORVALLIS
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State | OR
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Zip | 97330-3465
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Country | US
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Telephone | 503-528-6864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE LARKIN
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Credential |
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Telephone | 503-528-6864
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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 |
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License Number State |
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