Provider Demographics
NPI:1174997423
Name:VALLEYVIEW INJURY & PHYSICAL MEDICINE, PC
Entity type:Organization
Organization Name:VALLEYVIEW INJURY & PHYSICAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-484-6128
Mailing Address - Street 1:2850 SE POWELL VALLEY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1494
Mailing Address - Country:US
Mailing Address - Phone:503-489-1998
Mailing Address - Fax:503-489-1975
Practice Address - Street 1:2850 SE POWELL VALLEY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1494
Practice Address - Country:US
Practice Address - Phone:503-489-1998
Practice Address - Fax:503-489-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3626111NR0400X
OR3347111NR0400X
ORAC161122171100000X
ORPA174721363A00000X
ORDO19719204D00000X
OR4006175F00000X
OR1748092083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty