NPIMap

Organization Active NPI

Low Five Productions, LLC

Doing business as Mandon Welch Physical Therapy and Sport Performance

  • Physical Therapy Clinic/Center
  • Bend, OR
National Provider Identifier
1558861823
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
05361 Issued in OR
Legal business name
LOW FIVE PRODUCTIONS, LLC
Doing business as
Mandon Welch Physical Therapy and Sport Performance
Mandon Welch Therapeutics
Practice address
2753 NW Lolo Dr
Bend, OR 97703-7288
Phone
(541) 728-3412
Fax
(541) 610-1504
NPI assigned
Feb 13, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Mandon Porter Welch, PTNPI 1417079088
Title
Owner
Phone
(541) 728-3412

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 Therapy Clinic/Center 261QP2000X 05361 OR Primary

Addresses

Primary practice location

2753 NW Lolo Dr
Bend, OR 97703-7288

Mailing address

21090 Via Sandia
Bend, OR 97702-9588
Phone (541) 728-3412

Other names 2

  • Mandon Welch Physical Therapy and Sport Performance Doing business as
  • Mandon Welch Therapeutics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180309001188 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0840551784 Receives reassigned benefits from 4 practitioners
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

2783 NW Lolo Dr
Ste 120
Bend, OR 97703

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1558861823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21090 VIA SANDIA",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977029588",
            "telephone_number": "541-728-3412",
            "fax_number": "541-610-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2753 NW LOLO DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037288",
            "telephone_number": "541-728-3412",
            "fax_number": "541-610-1504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW FIVE PRODUCTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "MANDON",
        "authorized_official_middle_name": "PORTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-728-3412",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "05361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mandon Welch Physical Therapy and Sport Performance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mandon Welch Therapeutics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.