NPIMap

Organization Active NPI

Impact Physical Therapy, LLC

  • Physical Therapist
  • Grants Pass, OR
National Provider Identifier
1083655260
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IMPACT PHYSICAL THERAPY, LLC
Practice address
625 Ramsey Ave
Suite B
Grants Pass, OR 97527-5808
Phone
(541) 476-1919
Fax
(541) 476-1920
NPI assigned
Jun 9, 2006
Last updated
Feb 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Carie A Campos
Title
Office Manager
Phone
(541) 476-1919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

625 Ramsey Ave
Suite B
Grants Pass, OR 97527-5808

Mailing address

625 Ramsey Ave
Suite B
Grants Pass, OR 97527-5808
Phone (541) 476-1919

Other identifiers 1

IdentifierTypeStateIssuer
CG5252OtherORMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Locations

1309 NE 7th St
Ste C
Grants Pass, OR 97526
Phone (541) 287-2232

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1083655260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 RAMSEY AVE",
            "address_2": "SUITE B",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275808",
            "telephone_number": "541-476-1919",
            "fax_number": "541-476-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 RAMSEY AVE",
            "address_2": "SUITE B",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275808",
            "telephone_number": "541-476-1919",
            "fax_number": "541-476-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "CARIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "541-476-1919"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG5252",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.