Provider Demographics
NPI:1255882635
Name:SAMPSON PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:SAMPSON PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-388-2681
Mailing Address - Street 1:121 NW GREENWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2079
Mailing Address - Country:US
Mailing Address - Phone:541-388-2681
Mailing Address - Fax:541-388-9236
Practice Address - Street 1:121 NW GREENWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2079
Practice Address - Country:US
Practice Address - Phone:541-388-2681
Practice Address - Fax:541-388-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16869140261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy