Provider Demographics
NPI:1457577553
Name:ENDEAVOR PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ENDEAVOR PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SUNDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-559-2627
Mailing Address - Street 1:19856 SE HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-5743
Mailing Address - Country:US
Mailing Address - Phone:417-559-2627
Mailing Address - Fax:503-386-2745
Practice Address - Street 1:19856 SE HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-5743
Practice Address - Country:US
Practice Address - Phone:417-559-2627
Practice Address - Fax:503-386-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4180650-98225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty