NPIMap

Organization Active NPI

Willamette Spine Center Physical Therapy & Rehabilitation, LLC

  • Physical Therapist
  • Salem, OR
National Provider Identifier
1063548329
Registry record updated Jul 31, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WILLAMETTE SPINE CENTER PHYSICAL THERAPY & REHABILITATION, LLC
Practice address
2480 Liberty St NE Ste 140
Salem, OR 97303-6781
Phone
(503) 763-3525
Fax
(503) 763-3526
NPI assigned
Feb 23, 2007
Last updated
Jul 31, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Charles Gibbons, PTNPI 1659352441
Title
Owner and Physical Therapist
Phone
(503) 763-3525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

2480 Liberty St NE Ste 140
Salem, OR 97303-6781

Mailing address

2480 Liberty St NE Ste 140
Salem, OR 97303-6781
Phone (503) 763-3525

Other names 1

  • WSC Physical Therapy Other name

National Provider Directory

National Provider Directory

Locations

4999 Skyline Rd S
Ste 90
Salem, OR 97306
Phone (503) 566-7700

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248998400000",
    "number": "1063548329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 LIBERTY ST NE STE 140",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973036781",
            "telephone_number": "503-763-3525",
            "fax_number": "503-763-3526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LIBERTY ST NE STE 140",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973036781",
            "telephone_number": "503-763-3525",
            "fax_number": "503-763-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE SPINE CENTER PHYSICAL THERAPY & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2009-07-31",
        "status": "A",
        "authorized_official_last_name": "GIBBONS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER AND PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "503-763-3525",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WSC Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.