Active NPI
Lebanon Physical Therapy, LLC
- Physical Therapist
- Lebanon, OR
National Provider Identifier
1598539017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- LEBANON PHYSICAL THERAPY, LLC
- Practice address
- 1195 S Main St
Lebanon, OR 97355-3217 - Phone
- (541) 401-6500
- NPI assigned
- Nov 15, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dan Jenkins, DPT
- Title
- Owner
- Phone
- (650) 235-0545
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
1195 S Main St
Lebanon, OR 97355-3217
Mailing address
1195 S Main St
Lebanon, OR 97355-3217
Phone (541) 401-6500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240415003476 | OR | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 3375982036 |
Receives reassigned benefits from 4 practitioners Practice locations: Lebanon, OR |
National Provider Directory
National Provider DirectoryLocations
1195 S Main St
Lebanon, OR 97355
Phone (541) 401-6500
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700006400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1713312000000",
"number": "1598539017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1195 S MAIN ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553217",
"telephone_number": "541-401-6500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1195 S MAIN ST",
"city": "LEBANON",
"state": "OR",
"postal_code": "973553217",
"telephone_number": "541-401-6500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEBANON PHYSICAL THERAPY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-11-15",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A",
"authorized_official_last_name": "JENKINS",
"authorized_official_first_name": "DAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "650-235-0545",
"authorized_official_credential": "DPT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.