Bradshaw Physical Therapy & Wellness Center LLC
Organization Active NPI Orthopedic Physical Therapist · Talent, OR
NPI 1609934504 · NPPES record last updated Feb 1, 2019
Key facts
- NPI
- 1609934504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 2192 (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
- Organization subpart
- No
Authorized official
- Name
- Roger B Bradshaw, P.T.
- Title
- Physical Therapist Business Owner
- Phone
- (541) 482-3126
Practitioners 3
-
Gregory Matthew Newell, MSPT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040727000625 | OR | Part B Supplier - Clinic/Group Practice | 6002886231 |
Receives reassigned benefits from 1 practitioner Practice locations: Ashland, OR |
National Provider Directory
Locations
184 Clear Creek Dr
Ste 1
Ashland, OR 97520
Phone (541) 201-3201
223 Wintersage Cir
Unit A
Talent, OR 97540
Phone (541) 482-3126
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist |
2251X0800X | 2192 | OR | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 230041 | Medicaid | OR | |
| 838049001 | Other | OR | BCBS |
| 122002900 | Other | OR | US DEPT. OF LABOR |
| L5250-01 | Other | OR | PACIFICSOURCE |
Other providers in Talent, OR
- Barbara Linda Berg
- Rodney S Birney
- Caitlin Alexandra Bishop
- Body in Context
- Sharon Elisabeth Bolles
- Roger B Bradshaw
- Mira Brockelman
- Amy Frances Burlison
- Mercedes Joanne Burt
- Mary Elizabeth Caron
All providers in Talent, OR · Orthopedic Physical Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.