NPIMap

Organization Active NPI

Bradshaw Physical Therapy & Wellness Center LLC

  • Orthopedic Physical Therapist
  • Talent, OR
National Provider Identifier
1609934504
Registry record updated Feb 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
2192 Issued in OR
Legal business name
BRADSHAW PHYSICAL THERAPY & WELLNESS CENTER LLC
Practice address
223 Wintersage Cir Unit a
Talent, OR 97540-9515
Phone
(541) 482-3126
Fax
(541) 482-0593
NPI assigned
Dec 4, 2006
Last updated
Feb 1, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2019

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

Authorized official

Name
Roger B Bradshaw, P.T.NPI 1841235173
Title
Physical Therapist Business Owner
Phone
(541) 482-3126

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 2192 OR Primary

Addresses

Primary practice location

223 Wintersage Cir Unit a
Talent, OR 97540-9515

Mailing address

223 Wintersage Cir Unit a
Talent, OR 97540-9566
Phone (541) 482-3126

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040727000625 OR Part B Supplier - Clinic/Group Practice 6002886231 Receives reassigned benefits from 1 practitioner
Practice locations: Ashland, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548979200000",
    "number": "1609934504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 WINTERSAGE CIR UNIT A",
            "city": "TALENT",
            "state": "OR",
            "postal_code": "975409566",
            "telephone_number": "541-482-3126",
            "fax_number": "541-482-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 WINTERSAGE CIR UNIT A",
            "city": "TALENT",
            "state": "OR",
            "postal_code": "975409515",
            "telephone_number": "541-482-3126",
            "fax_number": "541-482-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADSHAW PHYSICAL THERAPY & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2019-02-01",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST BUSINESS OWNER",
        "authorized_official_telephone_number": "541-482-3126",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "2192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Talent, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.