Provider Demographics
NPI: | 1023025590 |
---|---|
Name: | OREGON SPINE AND PHYSICAL THERAPY |
Entity Type: | Organization |
Organization Name: | OREGON SPINE AND PHYSICAL THERAPY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JUDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CIRULLO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 541-895-5913 |
Mailing Address - Street 1: | PO BOX 363 |
Mailing Address - Street 2: | |
Mailing Address - City: | CRESWELL |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97426-0363 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 541-895-5913 |
Mailing Address - Fax: | 541-895-5941 |
Practice Address - Street 1: | 182 MELTON ROAD |
Practice Address - Street 2: | |
Practice Address - City: | CRESWELL |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97426 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-895-5913 |
Practice Address - Fax: | 541-895-5941 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-01 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
Not Answered | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Single Specialty |
Not Answered | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Single Specialty |
Not Answered | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Single Specialty |
Not Answered | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
Not Answered | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Single Specialty |
Not Answered | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |
Not Answered | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty |