Provider Demographics
NPI:1306813795
Name:OREGON MEDICAL GROUP AT THURSTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OREGON MEDICAL GROUP AT THURSTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:SCHWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-242-4178
Mailing Address - Street 1:5781 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5781 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5426
Practice Address - Country:US
Practice Address - Phone:541-284-1694
Practice Address - Fax:541-242-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty