Provider Demographics
NPI:1497385215
Name:CAPACITY PERFORMANCE THERAPY
Entity Type:Organization
Organization Name:CAPACITY PERFORMANCE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CAPACITY PERFORMANCE THERA
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-224-7485
Mailing Address - Street 1:61125 LODGEPOLE DR.
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-224-7485
Mailing Address - Fax:
Practice Address - Street 1:61125 LODGEPOLE DR.
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-224-7485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty