Active NPI
Cody William Serdar, PT, DPT
- Physical Therapist
- Corvallis, OR
National Provider Identifier
1619242567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 60142
- Practice address
- 815 NW 9TH St Ste 180
Corvallis, OR 97330-6173 - Phone
- (541) 768-5157
- NPI assigned
- Mar 11, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 38742 | CA | |
| Physical Therapist | 225100000X | 60142 | OR | Primary |
Addresses
Primary practice location
815 NW 9TH St Ste 180
Corvallis, OR 97330-6173
Mailing address
PO Box 1189
Corvallis, OR 97339-1189
Other practice location 1
4090 Rosenda CT 199
San Diego, CA 92122-1958
Phone (360) 356-5702
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cserdar126871@samhealth.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38742 | CA | MD | Pharmacist |
| 60142 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1619242567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1189",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973391189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 NW 9TH ST STE 180",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973306173",
"telephone_number": "541-768-5157"
}
],
"practiceLocations": [
{
"address_1": "4090 Rosenda CT 199",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921221958",
"country_code": "US",
"telephone_number": "360-356-5702",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SERDAR",
"first_name": "CODY",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-03-11",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "38742",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "60142",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cserdar126871@samhealth.direct-ci.com",
"affiliation": "N",
"address_1": "815 NW 9th St Ste 180",
"city": "Corvallis",
"state": "OR",
"country_code": "US",
"postal_code": "973306173",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.