Provider Demographics
NPI:1831585033
Name:ADVANTAGE PHYSICAL THERAPY AND HEALTH EDUCATION CENTER, LLC
Entity type:Organization
Organization Name:ADVANTAGE PHYSICAL THERAPY AND HEALTH EDUCATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAECHEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:503-368-4978
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:NEHALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97131-0278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:278 ROWE RD
Practice Address - Street 2:STE 224
Practice Address - City:WHEELER
Practice Address - State:OR
Practice Address - Zip Code:97147-0035
Practice Address - Country:US
Practice Address - Phone:503-368-4978
Practice Address - Fax:503-368-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty