Provider Demographics
NPI:1083813950
Name:RAECHEL J. MASSIE
Entity Type:Organization
Organization Name:RAECHEL J. MASSIE
Other - Org Name:ADVANTAGE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAECHEL
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:503-368-4978
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:NEHALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97131-0278
Mailing Address - Country:US
Mailing Address - Phone:503-368-4978
Mailing Address - Fax:503-368-4979
Practice Address - Street 1:278 ROWE STREET
Practice Address - Street 2:2ND FLOOR NORTH
Practice Address - City:WHEELER
Practice Address - State:OR
Practice Address - Zip Code:97147
Practice Address - Country:US
Practice Address - Phone:503-368-4978
Practice Address - Fax:503-368-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2437261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067133000OtherREGENCE BLUE CROSS BLUE S
OR067133000OtherREGENCE BLUE CROSS BLUE S