Provider Demographics
NPI:1518181809
Name:SOUTHWEST PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY
Other - Org Name:BROOKINGS HARBOR 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:541-269-7212
Mailing Address - Street 1:PO BOX 1211
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0114
Mailing Address - Country:US
Mailing Address - Phone:541-469-1062
Mailing Address - Fax:
Practice Address - Street 1:614 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-469-1062
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR047147Medicaid