Provider Demographics
NPI:1235311713
Name:SALEM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SALEM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARQUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-581-7232
Mailing Address - Street 1:33423 SW LADD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7548
Mailing Address - Country:US
Mailing Address - Phone:503-625-7954
Mailing Address - Fax:
Practice Address - Street 1:1270 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4113
Practice Address - Country:US
Practice Address - Phone:503-581-7232
Practice Address - Fax:503-581-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
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
OR089892Medicaid
OR0000WCHCWMedicare PIN