NPIMap

Organization Active NPI

Eastern Oregon Physical Therapy Hermiston LLC

  • Physical Therapist
  • Hermiston, OR
National Provider Identifier
1124043633
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
110326-2401 Issued in UT
Legal business name
EASTERN OREGON PHYSICAL THERAPY HERMISTON LLC
Practice address
1725 N 1St St Ste D
Hermiston, OR 97838-1682
Phone
(541) 567-5678
Fax
(541) 567-2110
NPI assigned
Jul 13, 2006
Last updated
Dec 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Authorized official

Name
Amanda Carnine, PTNPI 1376808881
Title
Owner
Phone
(406) 531-5918

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 110326-2401 UT Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

1725 N 1St St Ste D
Hermiston, OR 97838-1682

Mailing address

PO Box 90
Sunnyside, WA 98944-0090
Phone (541) 567-5678

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050825001092 OR Part B Supplier - Clinic/Group Practice 8527099894 Receives reassigned benefits from 5 practitioners
Practice locations: Hermiston, OR; Umatilla, OR

National Provider Directory

National Provider Directory

Locations

1050 W Elm Ave
Ste 130
Hermiston, OR 97838
Phone (541) 567-5678

1725 N 1st St
Ste D
Hermiston, OR 97838
Phone (541) 567-5678

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1124043633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989440090",
            "telephone_number": "541-567-5678",
            "fax_number": "541-567-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 N 1ST ST STE D",
            "city": "HERMISTON",
            "state": "OR",
            "postal_code": "978381682",
            "telephone_number": "541-567-5678",
            "fax_number": "541-567-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN OREGON PHYSICAL THERAPY HERMISTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "CARNINE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-531-5918",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "110326-2401",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermiston, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.