Individual provider Active NPI

Tess Kreofsky

  • Physical Therapist
  • Corvallis, OR
National Provider Identifier
1154075323
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
64314 Issued in OR
Practice address
2635 NW Rolling Green Dr
Corvallis, OR 97330-3519
Phone
(541) 752-0545
NPI assigned
Feb 7, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 64314 OR Primary

Addresses

Primary practice location

2635 NW Rolling Green Dr
Corvallis, OR 97330-3519

Mailing address

2635 NW Rolling Green Dr
Corvallis, OR 97330-3519
Phone (541) 752-0545

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220222000967 OR Practitioner - Physical Therapist in Private Practice 5991199747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Corvallis Sport and Spine Physical Therapy IncGroup PAC ID 2961469333, 15 clinicians

Practice addresses (Care Compare)

2635 NW Rolling Green Dr
Corvallis, OR 97330-3519
Phone (541) 752-0545

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Corvallis Sport and Spine Physical Therapy Inc Single Specialty CurrentSince Feb 14, 2022 Accepting new patients
Corvallis Sport and Spine Physical Therapy Inc Single Specialty PastSince Feb 13, 2022 Accepting new patients

Locations

613 Hickory St NW
Ste 120
Albany, OR 97321

613 Hickory St NW
Albany, OR 97321
Phone (541) 753-4246

2635 NW Rolling Green Dr
Corvallis, OR 97330
Phone (541) 752-0545

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.

NPI Registry JSON

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1154075323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 NW ROLLING GREEN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303519",
            "telephone_number": "541-752-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 NW ROLLING GREEN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303519",
            "telephone_number": "541-752-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREOFSKY",
        "first_name": "TESS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "64314",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.