Ricardo Gonzalez, PT, DPT
Individual provider Active NPI Physical Therapist · Stayton, OR
NPI 1669069720 · NPPES record last updated Dec 23, 2020
Key facts
- NPI
- 1669069720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 63948 (OR)
- Practice address
- 1750 Wilco Rd
Stayton, OR 97383-1085 - Phone
- (503) 769-7131
- Fax
- (503) 769-7132
- NPI assigned
- Dec 23, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Healing Motion Physical Therapy, Inc.
Practice addresses (Care Compare)
340 Vista Ave SE
Suite 250
Salem, OR 97302-4546
Phone (971) 301-6225
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231113001514 | OR | Practitioner - Physical Therapist in Private Practice | 9739536772 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Motion Physical Therapy, Inc. | Physical Therapist | Current |
Accepting new patients |
| Physical Therapy Northwest Limited Partnership | Physical Therapist | Current |
Accepting new patients |
| PT Northwest LLC | Past |
Accepting new patients | |
| Pediatric Therapy Services Inc | Past | Accepting new patients |
Locations
732 Main St
Philomath, OR 97370
Phone (541) 929-2255
340 Vista Ave SE
Ste 250
Salem, OR 97302
Phone (971) 301-6225
685 36th Ave NE
Salem, OR 97301
Phone (503) 371-8860
1750 Wilco Rd
Stayton, OR 97383
Phone (503) 769-7131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 63948 | OR | Yes |
Addresses
Primary practice location
1750 Wilco Rd
Stayton, OR 97383-1085
Mailing address
685 36TH Ave NE
Salem, OR 97301-4741
Phone (503) 371-8860
Other providers in Stayton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.