Provider Demographics
NPI:1225200595
Name:REHABILITATION ASSOCIATES NORTHWEST
Entity Type:Organization
Organization Name:REHABILITATION ASSOCIATES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GORTHEY
Authorized Official - Last Name:BOTTOMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-757-7269
Mailing Address - Street 1:2211 NW PROFESSIONAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3891
Mailing Address - Country:US
Mailing Address - Phone:541-757-7269
Mailing Address - Fax:541-757-7465
Practice Address - Street 1:2211 NW PROFESSIONAL DR
Practice Address - Street 2:STE 100
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3891
Practice Address - Country:US
Practice Address - Phone:541-757-7269
Practice Address - Fax:541-757-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR132051Medicare PIN