# CALDERA PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104501600
- **Authorized official:** VICTORIA D'AUTEUIL PT (OWNER)
- **Authorized official phone:** (541) 585-0313

## Contact information

- **Practice address:** 57031 PONDEROSA RD, BLDG. 27 SUITE M2, SUNRIVER, OR 97707-8708
- **Practice address phone:** (541) 585-0313
- **Practice address fax:** (541) 585-0312
- **Mailing address:** 16675 MASTEN MILL DR, LA PINE, OR 97739-8708
- **Mailing address phone:** (180) 828-3259

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/21/2023
- **Last updated:** 09/19/2023