Provider Demographics
NPI:1013112903
Name:JACKSON COUNTY PHYSICAL THERAPY LLP
Entity Type:Organization
Organization Name:JACKSON COUNTY PHYSICAL THERAPY LLP
Other - Org Name:JACKSON COUNTY PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-776-2333
Mailing Address - Street 1:36 HAWTHORNE ST.
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7114
Mailing Address - Country:US
Mailing Address - Phone:541-776-2333
Mailing Address - Fax:541-776-2495
Practice Address - Street 1:36 HAWTHORNE ST.
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7114
Practice Address - Country:US
Practice Address - Phone:541-776-2333
Practice Address - Fax:541-776-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2015-06-08
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
ORCK6710OtherRAILROAD MC
OR131362Medicaid
ORR0000WFBFFMedicare PIN