NPIMap

Organization Active NPI

Southside Physical Therapy, Inc.

  • Physical Therapist
  • Bend, OR
National Provider Identifier
1538161237
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3911 Issued in OR
Legal business name
SOUTHSIDE PHYSICAL THERAPY, INC.
Practice address
364 SE Wilson Ave
Bend, OR 97702-1711
Phone
(541) 388-2681
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2012

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

Authorized official

Name
Mrs. Laura GooldNPI 1770585770
Title
Owner,OT
Phone
(541) 388-2681

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 3911 OR Primary

Addresses

Primary practice location

364 SE Wilson Ave
Bend, OR 97702-1711

Mailing address

364 SE Wilson Ave
Bend, OR 97702-1711
Phone (541) 388-2681

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1538161237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 SE WILSON AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021711",
            "telephone_number": "541-388-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 SE WILSON AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021711",
            "telephone_number": "541-388-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "GOOLD",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER,OT",
        "authorized_official_telephone_number": "541-388-2681",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "3911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; 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.