Provider Demographics
NPI:1487202362
Name:MPT LLC
Entity Type:Organization
Organization Name:MPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ZINGG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-286-5516
Mailing Address - Street 1:PO BOX 4939
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0092
Mailing Address - Country:US
Mailing Address - Phone:541-286-5516
Mailing Address - Fax:
Practice Address - Street 1:98158 W BENHAM LN STE 10
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9546
Practice Address - Country:US
Practice Address - Phone:541-286-5516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy