Provider Demographics
NPI:1194833756
Name:CAPITOL PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CAPITOL PHYSICAL THERAPY, INC
Other - Org Name:CAPITOL PHYSICAL AND HAND THERAPY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-364-5313
Mailing Address - Street 1:410 MILL ST SE # 1045
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3601
Mailing Address - Country:US
Mailing Address - Phone:503-364-5313
Mailing Address - Fax:503-364-5296
Practice Address - Street 1:853 MEDICAL CENTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2752
Practice Address - Country:US
Practice Address - Phone:503-364-5313
Practice Address - Fax:503-364-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR103945Medicare PIN