Provider Demographics
NPI:1003978263
Name:CAPITOL PHYSICAL AND HAND THERAPY, INC
Entity Type:Organization
Organization Name:CAPITOL PHYSICAL AND HAND THERAPY, INC
Other - Org Name:CAPITOL PHYSICAL & HAND THERAPY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-910-9561
Mailing Address - Street 1:495 STATE ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3757
Mailing Address - Country:US
Mailing Address - Phone:503-910-9561
Mailing Address - Fax:503-400-7956
Practice Address - Street 1:6250 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1333
Practice Address - Country:US
Practice Address - Phone:503-485-1666
Practice Address - Fax:503-581-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR103945Medicare PIN