Provider Demographics
NPI:1932279916
Name:MEDFORD SPORTS INJURY & THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:MEDFORD SPORTS INJURY & THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZERKEL
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:541-779-6146
Mailing Address - Street 1:2780 E BARNETT RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8674
Mailing Address - Country:US
Mailing Address - Phone:541-779-6146
Mailing Address - Fax:
Practice Address - Street 1:2780 E BARNETT RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8674
Practice Address - Country:US
Practice Address - Phone:541-779-6146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165076Medicaid
OR165076Medicaid