Provider Demographics
NPI:1053607259
Name:SWEETGRASS PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:SWEETGRASS PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-450-8218
Mailing Address - Street 1:971 NW SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2234
Mailing Address - Country:US
Mailing Address - Phone:406-450-8218
Mailing Address - Fax:
Practice Address - Street 1:971 NW SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2234
Practice Address - Country:US
Practice Address - Phone:541-207-3436
Practice Address - Fax:541-207-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-26
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy