MEDICARE: VIBRANCE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1548736028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANCE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	4166 SKYWAY CT S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2773
Country	:	US
Telephone Number	:	503-510-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 TRIANGLE DR SE STE 140
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4566
Country	:	US
Telephone Number	:	503-510-5520
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HELEN AKERBERG EVANS
Credential	:
Telephone Number	:	503-510-5520

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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Directions to “VIBRANCE PHYSICAL THERAPY LLC ” Practice Location

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