Active NPI
Logan Thomas Richardson, P.T.
- Physical Therapist
- Corvallis, OR
National Provider Identifier
1124372404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 06993
- Practice address
- 996 NW Circle Blvd
Suite 101
Corvallis, OR 97330-1485 - Phone
- (541) 757-0878
- Fax
- (541) 757-0879
- NPI assigned
- Nov 7, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 06993 | OR | Primary |
Addresses
Primary practice location
996 NW Circle Blvd
Suite 101
Corvallis, OR 97330-1485
Mailing address
16083 SW Upper Boones Ferry Rd
Suite 300
Tigard, OR 97224-7736
Phone (800) 219-8835
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500652534 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Portland, OR
- NPI 1700862000
-
- Physical Therapist
- Bothell, WA
- NPI 1114376563
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361145600000",
"number": "1124372404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16083 SW UPPER BOONES FERRY RD",
"address_2": "SUITE 300",
"city": "TIGARD",
"state": "OR",
"postal_code": "972247736",
"telephone_number": "800-219-8835",
"fax_number": "503-639-9699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "996 NW CIRCLE BLVD",
"address_2": "SUITE 101",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973301485",
"telephone_number": "541-757-0878",
"fax_number": "541-757-0879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "LOGAN",
"middle_name": "THOMAS",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-07",
"last_updated": "2013-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "06993",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500652534",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.