Provider Demographics
NPI:1255413787
Name:PACIFIC CREST PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PACIFIC CREST PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:503-861-3550
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0008
Mailing Address - Country:US
Mailing Address - Phone:503-861-3550
Mailing Address - Fax:503-861-3559
Practice Address - Street 1:25 N. HWY 101
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-861-3550
Practice Address - Fax:503-861-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
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
OR105604Medicare ID - Type UnspecifiedPHYSICAL THERAPY