Provider Demographics
NPI:1114347549
Name:STEPPING OUT PHYSICAL THERAPY AND CUSTOM FEET ORTHOTICS
Entity Type:Organization
Organization Name:STEPPING OUT PHYSICAL THERAPY AND CUSTOM FEET ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-908-1943
Mailing Address - Street 1:3498 NW DEER RUN ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3111
Mailing Address - Country:US
Mailing Address - Phone:541-908-1943
Mailing Address - Fax:541-757-7907
Practice Address - Street 1:3498 NW DEER RUN ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3111
Practice Address - Country:US
Practice Address - Phone:541-908-1943
Practice Address - Fax:541-757-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty