Provider Demographics
NPI:1114136017
Name:LIVING WELL THERAPY, P.C.
Entity Type:Organization
Organization Name:LIVING WELL THERAPY, P.C.
Other - Org Name:LIVING WELL THERAPY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBONI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-312-2004
Mailing Address - Street 1:1558 SW NANCY WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3216
Mailing Address - Country:US
Mailing Address - Phone:541-312-2004
Mailing Address - Fax:541-312-2056
Practice Address - Street 1:1558 SW NANCY WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3216
Practice Address - Country:US
Practice Address - Phone:541-312-2004
Practice Address - Fax:541-312-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty