Provider Demographics
NPI:1326237769
Name:ACTION REHABILITATION & SPORTS MEDICINE, P.C.
Entity Type:Organization
Organization Name:ACTION REHABILITATION & SPORTS MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:541-472-1799
Mailing Address - Street 1:1619 NW HAWTHORNE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6008
Mailing Address - Country:US
Mailing Address - Phone:541-472-1799
Mailing Address - Fax:541-472-1699
Practice Address - Street 1:1619 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-6008
Practice Address - Country:US
Practice Address - Phone:541-472-1799
Practice Address - Fax:541-472-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR121175Medicare PIN