Provider Demographics
NPI:1356473979
Name:SISKIYOU PACIFIC, INC.
Entity Type:Organization
Organization Name:SISKIYOU PACIFIC, INC.
Other - Org Name:CENTRAL POINT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:W
Authorized Official - Last Name:EBERLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:541-664-5151
Mailing Address - Street 1:1208 BEALL LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1573
Mailing Address - Country:US
Mailing Address - Phone:541-664-5151
Mailing Address - Fax:877-772-9433
Practice Address - Street 1:512 MANZANITA ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2352
Practice Address - Country:US
Practice Address - Phone:541-664-5151
Practice Address - Fax:541-664-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy