NPIMap

Organization Active NPI

Southern Oregon Physical Therapy Associates Inc.

  • Physical Therapy Clinic/Center
  • Medford, OR
National Provider Identifier
1669698353
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SOUTHERN OREGON PHYSICAL THERAPY ASSOCIATES INC.
Practice address
924 S Riverside Ave
Medford, OR 97501-7842
Phone
(541) 773-7678
Fax
(541) 773-5517
NPI assigned
Apr 18, 2007
Last updated
Jun 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Authorized official

Name
Leesa D Nystrom, PTNPI 1801896535
Title
President
Phone
(541) 773-7678

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 Therapy Clinic/Center 261QP2000X OR Primary

Addresses

Primary practice location

924 S Riverside Ave
Medford, OR 97501-7842

Mailing address

924 S Riverside Ave
Medford, OR 97501-7842
Phone (541) 773-7678

National Provider Directory

National Provider Directory

Locations

924 S Riverside Ave
Medford, OR 97501
Phone (541) 773-7678

Practitioners & affiliated clinicians

Practitioners 4

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": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1669698353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 S RIVERSIDE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017842",
            "telephone_number": "541-773-7678",
            "fax_number": "541-773-5517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 S RIVERSIDE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017842",
            "telephone_number": "541-773-7678",
            "fax_number": "541-773-5517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OREGON PHYSICAL THERAPY ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "NYSTROM",
        "authorized_official_first_name": "LEESA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-773-7678",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.