Provider Demographics
NPI:1881913929
Name:MADRAS PHYSICAL THERAPY GROUP INC.
Entity type:Organization
Organization Name:MADRAS PHYSICAL THERAPY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-475-2571
Mailing Address - Street 1:910 SW HIGHWAY 97
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9247
Mailing Address - Country:US
Mailing Address - Phone:541-475-2571
Mailing Address - Fax:541-475-2590
Practice Address - Street 1:910 SW HIGHWAY 97
Practice Address - Street 2:SUITE 200
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9247
Practice Address - Country:US
Practice Address - Phone:541-475-2571
Practice Address - Fax:541-475-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty