Provider Demographics
NPI:1851407464
Name:SOUTHWEST PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY LLC
Other - Org Name:JOHN BREUER REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREUER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-269-7212
Mailing Address - Street 1:1650 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2170
Mailing Address - Country:US
Mailing Address - Phone:541-269-7212
Mailing Address - Fax:541-267-5260
Practice Address - Street 1:1650 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2170
Practice Address - Country:US
Practice Address - Phone:541-269-7212
Practice Address - Fax:541-267-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
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
OR207027Medicaid
OR386514Medicare Oscar/Certification