Provider Demographics
NPI:1881746220
Name:DOWNTOWN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:DOWNTOWN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-687-9314
Mailing Address - Street 1:999 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3112
Mailing Address - Country:US
Mailing Address - Phone:541-687-9314
Mailing Address - Fax:888-972-6544
Practice Address - Street 1:999 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3112
Practice Address - Country:US
Practice Address - Phone:541-687-9314
Practice Address - Fax:888-972-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1991261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028310Medicaid
OR117364Medicare ID - Type Unspecified
OR028310Medicaid