Organization
ACTIVE LIFE PHYSICAL THERAPY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK W DODGEN PT (PHYSICAL THERAPIST)
(541) 412-3717
Entity
Organization
Contact information
Practice address
616 HEMLOCK STREET, A, BROOKINGS, OR 97415-9412
(541) 412-1155
Mailing address
PO BOX 1628, BROOKINGS, OR 97415-0039
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3572
OR
Other
Enumeration date
12/18/2006
Last updated
10/22/2007
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