Provider Demographics
NPI:1891432860
Name:SOAR CONCIERGE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOAR CONCIERGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DEGN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-341-0382
Mailing Address - Street 1:3589 FAIRVIEW INDUSTRIAL DR SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3589 FAIRVIEW INDUSTRIAL DR SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1155
Practice Address - Country:US
Practice Address - Phone:503-341-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy