# PIONEER MEMORIAL PHYSICAL THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pioneer Memorial Physical Therapy LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760400956
- **Authorized official:** AMANDA CARNINE PT (OWNER)
- **Authorized official phone:** (406) 531-5918

## Contact information

- **Practice address:** 695 S ALFALFA STREET, HEPPNER, OR 97836-6300
- **Practice address phone:** (541) 676-1123
- **Practice address fax:** (541) 676-1122
- **Mailing address:** PO BOX 70689, SALT LAKE CITY, UT 84170-0689
- **Mailing address phone:** (801) 987-8600
- **Mailing address fax:** (801) 987-8601

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 5020 | OR | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 11/13/2024