Provider Demographics
NPI:1811392558
Name:LIFE FORCE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:LIFE FORCE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-935-0761
Mailing Address - Street 1:88267 TERRITORIAL RD STE 10A
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9499
Mailing Address - Country:US
Mailing Address - Phone:541-935-0761
Mailing Address - Fax:541-935-0536
Practice Address - Street 1:88267 TERRITORIAL RD STE 10A
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487
Practice Address - Country:US
Practice Address - Phone:541-935-0761
Practice Address - Fax:541-935-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty