Provider Demographics
NPI:1477991149
Name:CORVALLIS SPORT AND SPINE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:CORVALLIS SPORT AND SPINE PHYSICAL THERAPY INC
Other - Org Name:ALBANY SPORT AND SPINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:541-752-0545
Mailing Address - Street 1:617 HICKORY ST NW
Mailing Address - Street 2:STE. #160
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1764
Mailing Address - Country:US
Mailing Address - Phone:541-753-4246
Mailing Address - Fax:541-753-4256
Practice Address - Street 1:617 HICKORY ST NW STE 160
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1765
Practice Address - Country:US
Practice Address - Phone:541-928-1411
Practice Address - Fax:541-753-4256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORVALLIS SPORT AND SPINE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-04
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty