Basic Information
| Provider Information | |||||||||
| NPI: | 1003978263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITOL PHYSICAL AND HAND THERAPY, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAPITOL PHYSICAL & HAND THERAPY, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 STATE ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039109561 | ||||||||
| FaxNumber: | 5034007956 | ||||||||
| Practice Location | |||||||||
| Address1: | 6250 COMMERCIAL ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973061333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034851666 | ||||||||
| FaxNumber: | 5035816867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 05/28/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5039109561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | OR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.