ACTIVE LIFE PHYSICAL THERAPY CENTER INC (NPI# 1962565291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962565291 |
| Entity Type | Organization |
| Organization Name | ACTIVE LIFE PHYSICAL THERAPY CENTER INC |
| Practice Address |
616 Hemlock Street A Brookings OR 97415-9412 |
| Mailing Address |
Po Box 1628 Brookings OR 97415-0039 |
| Practice Telephone | 5414121155 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-10-22 |
| Authorized Official Name | MR. PATRICK W DODGEN (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 5414123717 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
3572 | OR | Ambulatory Health Care Facilities |
| Street Address |
616 HEMLOCK STREET A |
| City | BROOKINGS |
| State | OR |
| Zip Code | 97415-9412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932212669 | Patrick W Dodgen | Physical Therapist | 616 Hemlock Street, A, Brookings, OR 97415 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013549575 | Christopher Scott Mayo Jr. | Denturist | 937 Chetco Ave Ste. B, Brookings, OR 97415 | 2020-02-12 |
| 1912564329 | Lori A Burkart | Speech-Language Pathologist | Curry Medical Ctr, 500 5th Street, Brookings, OR 97415 | 2019-05-21 |
| 1881144178 | Costa Clinical Psychology, LLC | Social Worker | 625 Spruce St., # 7666, Brookings, OR 97415 | 2016-10-11 |
| 1194173898 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 410 Maple St, Brookings, OR 97415 | 2016-06-03 |
| 1336595784 | Monica Shaw | Case Manager/Care Coordinator | 412 Alder, Brookings, OR 97415 | 2016-05-04 |
| 1639531437 | Ian Leonard | Behavioral Analyst | 450 Sb Chetco River Road, Brookings, OR 97415 | 2016-03-22 |
| 1518201151 | Columbacare Services | Community Based Residential Treatment Facility, Mental Illness | 210 Cove Lane, Brookings, OR 97415 | 2012-11-20 |
| 1699033365 | Sunlight Family Center, LLC | Clinic/Center | 604 Spruce Street, Brookings, OR 97415 | 2012-05-01 |
| 1649544784 | Oregon Coast Wellness Inc. | Clinic/Center | 648 Chetco Ave., Brookings, OR 97415 | 2012-03-07 |
| 1790072544 | Elizabeth A. Nation | Registered Nurse | 96343 Alder Ridge Road, Brookings, OR 97415 | 2011-06-30 |
| Find all providers in zip 97415 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487202362 | Mpt LLC | Clinic/Center | 98158 W Benham Ln Ste 10, Brookings, OR 97415-9546 | 2019-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292639 | Blueprint Sports Therapy | Clinic/Center | 17440 Sw Reusser Ct, Beaverton, OR 97007-8772 | 2020-10-14 |
| 1790383982 | Fluid Movement LLC | Clinic/Center | 2565 Bowmont Dr, Eugene, OR 97405-1407 | 2020-10-11 |
| 1184221335 | Convergence Physical Therapy and Performance | Clinic/Center | 303 S 5th St Ste 140, Springfield, OR 97477-5480 | 2020-10-01 |
| 1356969976 | Readygo Physical Therapy LLC | Clinic/Center | 904 Se 69th Ave, Portland, OR 97215-2120 | 2020-07-09 |
| 1619591815 | Cyti LLC | Clinic/Center | 11350 Sw Canyon Rd # 202, Beaverton, OR 97005-2234 | 2020-06-03 |
| 1144865841 | St. Johns Physical Therapy | Clinic/Center | 8835 N Bradford St, Portland, OR 97203-2869 | 2019-11-18 |
| 1750930004 | Revolutions Physical Therapy LLC | Clinic/Center | 8751 Sw Pamlico Ct, Tualatin, OR 97062-9345 | 2019-09-10 |
| 1215584446 | Patrick Franko Pt LLC | Clinic/Center | 2331 Ne 43rd Ave, Portland, OR 97213-1332 | 2019-08-22 |
| 1689228686 | Ground Work Physical Therapy | Clinic/Center | 2330 Ne Division St Ste 1, Bend, OR 97703-3570 | 2019-07-29 |
| 1982261277 | Thrive Physical Therapy LLC | Clinic/Center | 6735 Sw Country Club Dr Ste 104, Corvallis, OR 97333-1987 | 2019-05-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.