Provider Demographics
NPI:1811201247
Name:RECLAIM PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RECLAIM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-636-4471
Mailing Address - Street 1:1144 WILLAGILLESPIE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6729
Mailing Address - Country:US
Mailing Address - Phone:541-636-4471
Mailing Address - Fax:541-357-4992
Practice Address - Street 1:1144 WILLAGILLESPIE RD STE 1
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6711
Practice Address - Country:US
Practice Address - Phone:541-636-4471
Practice Address - Fax:541-357-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5603261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy