Fairway Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

02521 Issued in OR

Legal business name

FAIRWAY PHYSICAL THERAPY, LLC

Practice address

211 Dakota St
Sutherlin, OR 97479-9908

Phone

(541) 315-2851

Fax

(541) 315-2853

NPI assigned

Nov 2, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Dan Wakefield Hirtle II, PT

Title

Owner/ Director

Phone

(541) 580-8106

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Z Jamantoc, PT

  • Physical Therapist
  • Mount Vernon, WA
  • NPI 1245403674
  NPD (past)

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

{
    "created_epoch": "1478044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1669924007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 DAKOTA ST",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799908",
            "telephone_number": "541-315-2851",
            "fax_number": "541-315-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 DAKOTA ST",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799908",
            "telephone_number": "541-315-2851",
            "fax_number": "541-315-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-02",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "HIRTLE",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "WAKEFIELD",
        "authorized_official_title_or_position": "OWNER/ DIRECTOR",
        "authorized_official_telephone_number": "541-580-8106",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "02521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1487639977",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelyn Leigh Dion
• Sunflower Maree Downer, CADC2, QMHA, CRM2,
• Mark T Drentlaw, DC
• Carol Ann Duncan, LMT
• Michael James Fain, HAS
• Lori Celeste Farley, M.S.O.M, L.AC.
• Zachary Allen Ferris, MA LPC
• Reed Leon Finlayson, M.ED.
• Katlynn Dianne Frasieur
• Fred Luke Herscher

• All providers in Sutherlin, OR
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; 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.