Provider Demographics
NPI:1124066170
Name:RECOVERY ZONE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:RECOVERY ZONE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TOSCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:P T
Authorized Official - Phone:541-850-8909
Mailing Address - Street 1:2846 EBERLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4402
Mailing Address - Country:US
Mailing Address - Phone:541-850-8909
Mailing Address - Fax:541-882-4005
Practice Address - Street 1:2846 EBERLEIN AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4402
Practice Address - Country:US
Practice Address - Phone:541-850-8909
Practice Address - Fax:541-882-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCK7573Medicare PIN
ORR114594Medicare PIN
ORR114549Medicare PIN
OR134279Medicare PIN
OR139335Medicare PIN