Obsidian Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

OBSIDIAN PHYSICAL THERAPY, LLC

Practice address

2420 NE Shadow Brook PL
Bend, OR 97701-6498

Phone

(541) 497-1533

NPI assigned

Feb 17, 2021

Organization subpart

No

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

Authorized official

Name

Katharine Holmer, DPT

Title

Owner/Therapist

Phone

(541) 497-1533

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1215520549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 NE HWY 20",
            "address_2": "STE 610 PMB #452",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 NE SHADOW BROOK PL",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016498",
            "telephone_number": "541-497-1533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSIDIAN PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "HOLMER",
        "authorized_official_first_name": "KATHARINE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "541-497-1533",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer O'Sullivan, LCSW
• Lauren Johnson O'Sullivan, D.O.
• Lauren Kaimana Oakley, RDH
• Kamie Ober, MA, LPC
• Chandler Robert Obermire, DC
• Obsidian Psychiatry LLC
• Alexander Ochman, DO
• Lisa Kelly Ochman, PT, DPT, CLT
• James Lee Ockner, MD
• Susan Oconnor

• Physical Therapy Clinic/Center in Bend, OR
• Providers in Bend, OR by specialty
• Physical Therapy Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.