Provider Demographics
NPI:1992975650
Name:WOMENS HEALTH PHYSICAL THERAPY OF EUGENE, LLC
Entity type:Organization
Organization Name:WOMENS HEALTH PHYSICAL THERAPY OF EUGENE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FORRESTALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-551-1099
Mailing Address - Street 1:395 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2869
Mailing Address - Country:US
Mailing Address - Phone:541-515-6215
Mailing Address - Fax:541-515-6216
Practice Address - Street 1:395 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2869
Practice Address - Country:US
Practice Address - Phone:541-515-6215
Practice Address - Fax:541-515-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-08
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3693261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy