# FAIRWAY PHYSICAL THERAPY, LLC

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

## Provider details

- **NPI number:** 1669924007
- **Authorized official:** MR. DAN WAKEFIELD HIRTLE II PT (OWNER/ DIRECTOR)
- **Authorized official phone:** (541) 580-8106

## Contact information

- **Practice address:** 211 DAKOTA ST, SUTHERLIN, OR 97479-9908
- **Practice address phone:** (541) 315-2851
- **Practice address fax:** (541) 315-2853
- **Mailing address:** 211 DAKOTA ST, SUTHERLIN, OR 97479-9908
- **Mailing address phone:** (541) 315-2851
- **Mailing address fax:** (541) 315-2853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 02521 | OR | Yes |

## Other

- **Enumeration date:** 11/02/2016
- **Last updated:** 11/02/2016