MEDICARE: REORDAN PHYSCIAL THERAPY, INC

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	:	1972635597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REORDAN PHYSCIAL THERAPY, INC

Provider Business Mailing Address
First Line	:	635 N 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9659
Country	:	US
Telephone Number	:	541-899-8179
Fax Number	:	541-899-0244

Provider Business Practice Location Address
First Line	:	635 N 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530-9659
Country	:	US
Telephone Number	:	541-664-5151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD REORDAN
Credential	:
Telephone Number	:	541-664-5151

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	05/04/2023

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