Provider Demographics
NPI:1316608193
Name:GO PHYSICAL THERAPY
Entity type:Organization
Organization Name:GO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTENBREIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-689-0935
Mailing Address - Street 1:1000 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3230
Mailing Address - Country:US
Mailing Address - Phone:541-689-0935
Mailing Address - Fax:541-461-6884
Practice Address - Street 1:1000 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3230
Practice Address - Country:US
Practice Address - Phone:541-689-0935
Practice Address - Fax:541-461-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty