Central Cascades Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1385 Issued in OR

Legal business name

CENTRAL CASCADES PHYSICAL THERAPY

Practice address

87520 Bay Road
Christmas Valley, OR 97641-0001

Phone

(541) 576-2110

Fax

(541) 598-0489

NPI assigned

Jun 8, 2005

Organization subpart

No

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

Authorized official

Name

Grover Dean Cockrum, P.T.

Title

C.E.O

Phone

(541) 576-2110

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1245234285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4520",
            "city": "SUNRIVER",
            "state": "OR",
            "postal_code": "977071520",
            "telephone_number": "541-576-2110",
            "fax_number": "541-598-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87520 BAY ROAD",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "976410001",
            "telephone_number": "541-576-2110",
            "fax_number": "541-598-0489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CASCADES PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "COCKRUM",
        "authorized_official_first_name": "GROVER",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "541-576-2110",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "1385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUECROSS/BLUESHI",
            "identifier": "808366001",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269080",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bruce D Carlson M.D.
• Dennis M. Bruneau, PA-C
• Alexandra Day
• Denise Lee Griffiths, FNP
• Larissa Briaun Hackett
• Shawn Kimberly Lavallee
• Emily Louise Merwin

• Physical Therapist in Christmas Valley, OR
• Providers in Christmas Valley, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.

Verify at the official NPI Registry.