Provider Demographics
NPI:1194095232
Name:ACHIEVE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ACHIEVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:541-672-5795
Mailing Address - Street 1:1931 NW MULHOLLAND DR. #1
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1978
Mailing Address - Country:US
Mailing Address - Phone:541-672-5795
Mailing Address - Fax:541-672-5796
Practice Address - Street 1:1931 NW MULHOLLAND DR. #1
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1978
Practice Address - Country:US
Practice Address - Phone:541-672-5795
Practice Address - Fax:541-672-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy