Provider Demographics
NPI:1699485888
Name:MOUNTAIN VIEW WELLNESS, PERFORMANCE & SPA, LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW WELLNESS, PERFORMANCE & SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:HOGGARTH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:541-892-6708
Mailing Address - Street 1:6510 S 6TH ST # 293
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7112
Mailing Address - Country:US
Mailing Address - Phone:541-205-8375
Mailing Address - Fax:
Practice Address - Street 1:6420 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7111
Practice Address - Country:US
Practice Address - Phone:541-892-6708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy