Provider Demographics
NPI:1679959571
Name:ALEVIA PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ALEVIA PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-210-5674
Mailing Address - Street 1:1345 CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7945
Mailing Address - Country:US
Mailing Address - Phone:541-210-5674
Mailing Address - Fax:541-210-5674
Practice Address - Street 1:1345 CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7945
Practice Address - Country:US
Practice Address - Phone:541-210-5674
Practice Address - Fax:541-210-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500705016Medicaid
ORR184077Medicare PIN