Provider Demographics
NPI:1003058363
Name:ALPINE PHYSICAL THERAPY AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:ALPINE PHYSICAL THERAPY AND WELLNESS CENTER INC
Other - Org Name:ALPINE PHYSICAL THERAPY & SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-382-5500
Mailing Address - Street 1:336 SW CYBER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1682
Mailing Address - Country:US
Mailing Address - Phone:541-382-5500
Mailing Address - Fax:541-389-5669
Practice Address - Street 1:336 SW CYBER DR
Practice Address - Street 2:SUITE 107
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1683
Practice Address - Country:US
Practice Address - Phone:541-382-5500
Practice Address - Fax:541-389-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669493Medicaid
ORR147235Medicare PIN