Organization
IMPACT PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARIE A CAMPOS (OFFICE MANAGER)
(541) 476-1919
Entity
Organization
Contact information
Practice address
625 RAMSEY AVE, SUITE B, GRANTS PASS, OR 97527-5808
(541) 476-1919
(541) 476-1920
Mailing address
625 RAMSEY AVE, SUITE B, GRANTS PASS, OR 97527-5808
(541) 476-1919
(541) 476-1920
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG5252
MEDICARE RAILROAD
OR
Enumeration date
06/09/2006
Last updated
02/20/2008
Update your record
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