Provider Demographics
NPI:1417787136
Name:SNOWFLAKE WARRIORS PHYSICAL THERAPY
Entity type:Organization
Organization Name:SNOWFLAKE WARRIORS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-910-0095
Mailing Address - Street 1:2209 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3711
Mailing Address - Country:US
Mailing Address - Phone:541-910-0095
Mailing Address - Fax:
Practice Address - Street 1:2209 N PINE ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3711
Practice Address - Country:US
Practice Address - Phone:541-910-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy