Provider Demographics
NPI:1740648245
Name:RESULTS NECK & BACK THERAPY LLC
Entity type:Organization
Organization Name:RESULTS NECK & BACK THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURLAI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-283-4139
Mailing Address - Street 1:20403 BUTTERMILK
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9490
Mailing Address - Country:US
Mailing Address - Phone:541-797-6316
Mailing Address - Fax:541-797-6319
Practice Address - Street 1:730 SW BONNETT WAY
Practice Address - Street 2:SUITE 3100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1192
Practice Address - Country:US
Practice Address - Phone:541-797-6316
Practice Address - Fax:541-797-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6205261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500645456Medicaid
OR500650825Medicaid
OR1588915623OtherNPI, INDIVIDUAL
1588604649OtherNPI, INDIVIDUAL
OR500645456Medicaid
ORR166767Medicare PIN