Provider Demographics
NPI:1558861823
Name:LOW FIVE PRODUCTIONS, LLC
Entity Type:Organization
Organization Name:LOW FIVE PRODUCTIONS, LLC
Other - Org Name:MANDON WELCH THERAPEUTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDON
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-728-3412
Mailing Address - Street 1:21090 VIA SANDIA
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9588
Mailing Address - Country:US
Mailing Address - Phone:541-728-3412
Mailing Address - Fax:541-610-1504
Practice Address - Street 1:2753 NW LOLO DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7288
Practice Address - Country:US
Practice Address - Phone:541-728-3412
Practice Address - Fax:541-610-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05361261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy