Provider Demographics
NPI:1992796452
Name:EUGENE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:EUGENE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-687-7005
Mailing Address - Street 1:54 OAKWAY CTR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5645
Mailing Address - Country:US
Mailing Address - Phone:541-687-7005
Mailing Address - Fax:541-687-7006
Practice Address - Street 1:54 OAKWAY CTR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5645
Practice Address - Country:US
Practice Address - Phone:541-687-7005
Practice Address - Fax:541-687-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227438Medicaid
OR227438Medicaid