Provider Demographics
NPI:1144420910
Name:NORTHWEST PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:NORTHWEST PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-957-5825
Mailing Address - Street 1:2510 NW EDENBOWER BLVD
Mailing Address - Street 2:#124
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8899
Mailing Address - Country:US
Mailing Address - Phone:541-957-5825
Mailing Address - Fax:541-957-5801
Practice Address - Street 1:2510 NW EDENBOWER BLVD
Practice Address - Street 2:#124
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8899
Practice Address - Country:US
Practice Address - Phone:541-957-5825
Practice Address - Fax:541-957-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR107889Medicare UPIN