Provider Demographics
NPI:1497979785
Name:SOUTHWEST PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY
Other - Org Name:GOLD BEACH PHYSICAL THERAPY & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-247-2254
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-1195
Mailing Address - Country:US
Mailing Address - Phone:541-247-2254
Mailing Address - Fax:
Practice Address - Street 1:29286 ELLENSBURG
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:541-247-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation