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Organization
FAIRWAY PHYSICAL THERAPY, LLC
Active
Organization
FAIRWAY PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAN WAKEFIELD HIRTLE II PT (OWNER/ DIRECTOR)
(541) 580-8106
Entity
Organization
Contact information
Practice address
211 DAKOTA ST, SUTHERLIN, OR 97479-9908
(541) 315-2851
(541) 315-2853
Mailing address
211 DAKOTA ST, SUTHERLIN, OR 97479-9908
(541) 315-2851
(541) 315-2853
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02521
OR
Other
Enumeration date
11/02/2016
Last updated
11/02/2016
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