Organization
NORTHEAST OREGON PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY DALE JOHNSTON PT (OWNER)
(541) 963-9340
Entity
Organization
Contact information
Practice address
700 SUNSET DR, STE B, LA GRANDE, OR 97850-1260
(541) 963-9340
(541) 963-4562
Mailing address
PO BOX 638, ELGIN, OR 97827-0638
(541) 963-9340
(541) 963-4562
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0557
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
838502000
BLUE CROSS
OR
Enumeration date
01/07/2010
Last updated
01/07/2010
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