# GREGORY ZADOW INC. P.S.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Green Ridge Physical Therapy & Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407802101
- **Authorized official:** CAROL DENISE STATTON (BILLING/CREDENTIALING MANAGER)
- **Authorized official phone:** (541) 299-0294

## Contact information

- **Practice address:** 325 N. LOCUST STREET, SISTERS, OR 97759
- **Practice address phone:** (541) 549-3534
- **Practice address fax:** (541) 549-1272
- **Mailing address:** PO BOX 1911, SISTERS, OR 97759-1911
- **Mailing address phone:** (541) 549-3534
- **Mailing address fax:** (541) 549-1272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4090 | OR | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 09/11/2023