Provider Demographics
NPI:1225613904
Name:COLUMBIA COUNTY MOBILE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COLUMBIA COUNTY MOBILE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEINZE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-610-1416
Mailing Address - Street 1:52436 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3332
Mailing Address - Country:US
Mailing Address - Phone:805-610-1416
Mailing Address - Fax:
Practice Address - Street 1:52436 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3332
Practice Address - Country:US
Practice Address - Phone:805-610-1416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty