Provider Demographics
NPI:1396268629
Name:MECHANOTHERAPY, LLC
Entity type:Organization
Organization Name:MECHANOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-903-1828
Mailing Address - Street 1:4975 SE DIVISION ST APT 348
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1574
Mailing Address - Country:US
Mailing Address - Phone:310-903-1828
Mailing Address - Fax:
Practice Address - Street 1:2232 NW PETTYGROVE ST STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2372
Practice Address - Country:US
Practice Address - Phone:310-903-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty