Provider Demographics
NPI:1811623614
Name:OREGON MOBILE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:OREGON MOBILE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:CORRIGAN
Authorized Official - Last Name:STROUP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:815-978-6512
Mailing Address - Street 1:23451 N UMPQUA HWY
Mailing Address - Street 2:
Mailing Address - City:GLIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97443-0277
Mailing Address - Country:US
Mailing Address - Phone:815-978-6512
Mailing Address - Fax:
Practice Address - Street 1:23451 N UMPQUA HWY
Practice Address - Street 2:
Practice Address - City:GLIDE
Practice Address - State:OR
Practice Address - Zip Code:97443-0277
Practice Address - Country:US
Practice Address - Phone:815-978-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty