Provider Demographics
NPI:1902440126
Name:THE VINTAGE PHYSICAL THERAPY AND TRAINING
Entity Type:Organization
Organization Name:THE VINTAGE PHYSICAL THERAPY AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-467-6046
Mailing Address - Street 1:26180 SW FRENCH OAK DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-9756
Mailing Address - Country:US
Mailing Address - Phone:503-467-6046
Mailing Address - Fax:503-296-5510
Practice Address - Street 1:1969 WILLAMETTE FALLS DR STE 100
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4660
Practice Address - Country:US
Practice Address - Phone:503-467-6046
Practice Address - Fax:503-296-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy