Provider Demographics
NPI:1538224084
Name:MCKENZIE CROSSING ORTHOPEDIC PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:MCKENZIE CROSSING ORTHOPEDIC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GESIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-988-3337
Mailing Address - Street 1:145 S 52ND PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6210
Mailing Address - Country:US
Mailing Address - Phone:541-988-3337
Mailing Address - Fax:541-988-3299
Practice Address - Street 1:145 S 52ND PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478
Practice Address - Country:US
Practice Address - Phone:541-988-3337
Practice Address - Fax:541-988-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109601Medicare ID - Type Unspecified