Provider Demographics
NPI:1710524269
Name:SUNRISE PHYSIO LLC
Entity Type:Organization
Organization Name:SUNRISE PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-216-6100
Mailing Address - Street 1:2797 NW CLEARWATER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7018
Mailing Address - Country:US
Mailing Address - Phone:541-216-6100
Mailing Address - Fax:
Practice Address - Street 1:2797 NW CLEARWATER DR STE 400
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7018
Practice Address - Country:US
Practice Address - Phone:541-216-6100
Practice Address - Fax:541-216-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty