Organization
PT NORTHWEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNEDY I HAWKINS (PRESIDENT GENERAL MANAGER)
(503) 540-8701
Entity
Organization
Contact information
Practice address
685 36TH AVE NE, SALEM, OR 97301-0005
(503) 371-8860
(503) 371-9299
Mailing address
685 36TH AVE NE, SALEM, OR 97301-4741
(503) 540-8701
(503) 371-8772
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
386522
MEDICARE ID TYPE UNSPECIFIED
OR
Enumeration date
12/28/2005
Last updated
06/12/2013
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