Provider Demographics
NPI:1831579226
Name:CENTER OF ORTHOPEDIC REHABILITATION & EXERCISE, LLC
Entity type:Organization
Organization Name:CENTER OF ORTHOPEDIC REHABILITATION & EXERCISE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:541-324-4807
Mailing Address - Street 1:771 W STEWART AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4001
Mailing Address - Country:US
Mailing Address - Phone:541-500-8029
Mailing Address - Fax:541-622-8337
Practice Address - Street 1:771 W STEWART AVE STE 103
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4001
Practice Address - Country:US
Practice Address - Phone:541-500-8029
Practice Address - Fax:541-622-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4611261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy