Provider Demographics
| NPI: | 1023025590 |
|---|---|
| Name: | OREGON SPINE AND PHYSICAL THERAPY |
| Entity type: | Organization |
| Organization Name: | OREGON SPINE AND PHYSICAL THERAPY |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JUDY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CIRULLO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT |
| Authorized Official - Phone: | 541-895-5913 |
| Mailing Address - Street 1: | PO BOX 363 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CRESWELL |
| Mailing Address - State: | OR |
| Mailing Address - Zip Code: | 97426-0363 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 541-895-5913 |
| Mailing Address - Fax: | 541-895-5941 |
| Practice Address - Street 1: | 182 MELTON ROAD |
| Practice Address - Street 2: | |
| Practice Address - City: | CRESWELL |
| Practice Address - State: | OR |
| Practice Address - Zip Code: | 97426 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 541-895-5913 |
| Practice Address - Fax: | 541-895-5941 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-01 |
| Last Update Date: | 2025-09-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Single Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Single Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Single Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Single Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |
