Provider Demographics
NPI:1073876041
Name:OREGON COASTAL REHAB
Entity Type:Organization
Organization Name:OREGON COASTAL REHAB
Other - Org Name:NEWPORT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DODGE
Authorized Official - Last Name:HASSELSCHWERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-265-4252
Mailing Address - Street 1:1010 SW COAST HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5239
Mailing Address - Country:US
Mailing Address - Phone:541-265-4252
Mailing Address - Fax:541-265-8914
Practice Address - Street 1:1010 SW COAST HWY STE 102
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5239
Practice Address - Country:US
Practice Address - Phone:541-265-4252
Practice Address - Fax:541-265-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117513Medicare UPIN