MEDICARE: BENCHMARK PHYSICAL THERAPY OF OREGON LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1669833620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCHMARK PHYSICAL THERAPY OF OREGON LLC

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 NE BEACON DR STE 101
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-4260
Country	:	US
Telephone Number	:	541-955-5181
Fax Number	:	541-955-7456

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	KEVIN JOHANNESON
Credential	:
Telephone Number	:	423-238-8923

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	03/17/2016

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Directions to “BENCHMARK PHYSICAL THERAPY OF OREGON LLC ” Practice Location

Language	Start Address	Practice Location

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