Active NPI
Cory Russell Crecelius, PT
- Physical Therapist
- Eugene, OR
National Provider Identifier
1689959348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6656
- Practice address
- 560 Country Club Pkwy
Suite B
Eugene, OR 97401-6043 - Phone
- (541) 683-5139
- Fax
- (514) 683-5783
- NPI assigned
- Oct 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6656 | OR | Primary |
Addresses
Primary practice location
560 Country Club Pkwy
Suite B
Eugene, OR 97401-6043
Mailing address
1624 W Main St
Jefferson City, MO 65109-1243
Phone (314) 583-5553
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 |
|---|---|---|---|
| 6656 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318464000000",
"number": "1689959348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1624 W MAIN ST",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651091243",
"telephone_number": "314-583-5553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 COUNTRY CLUB PKWY",
"address_2": "SUITE B",
"city": "EUGENE",
"state": "OR",
"postal_code": "974016043",
"telephone_number": "541-683-5139",
"fax_number": "514-683-5783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRECELIUS",
"first_name": "CORY",
"middle_name": "RUSSELL",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-13",
"last_updated": "2011-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "6656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.