Provider Demographics
NPI:1184215790
Name:ASPIRE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ASPIRE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-316-0805
Mailing Address - Street 1:371 SW UPPER TERRACE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1560
Mailing Address - Country:US
Mailing Address - Phone:541-316-0805
Mailing Address - Fax:541-241-7670
Practice Address - Street 1:371 SW UPPER TERRACE DR STE 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1560
Practice Address - Country:US
Practice Address - Phone:541-316-0805
Practice Address - Fax:541-241-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2024-08-06
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
OR500725277Medicaid