Farah Grace Custodio

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

64412 Issued in OR

Practice address

3838 Pacific Ave
Forest Grove, OR 97116-2224

Phone

(503) 357-1706

NPI assigned

Apr 26, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Custom Care Physical Therapy, LLCGroup PAC ID 0941365514, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Custom Care Physical Therapy, LLC.

  • Physical Therapy Clinic/Center
  • Forest Grove, OR
  • NPI 1508005026

  Single Specialty

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1740924620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 NW 123RD AVE APT 1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295673",
            "telephone_number": "503-804-1072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 PACIFIC AVE",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162224",
            "telephone_number": "503-357-1706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTODIO",
        "first_name": "FARAH",
        "middle_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-26",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "64412",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "64412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "OREGON",
            "affiliation": "Y",
            "affiliationName": "FYZICAL Therapy & Balance Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3838 Pacific Ave",
            "city": "Forest Grove",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971162224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan Robert Croft, PA-C
• Darcy Catherine Cruikshank, DMD MSD
• Elizabeth Cruz-Lopez
• Savonna Orinda Cudaback
• Benjamin C Curtis
• Custom Care Physical Therapy, LLC.
• Jordan Nicolas Cutaia
• Thuy Xuan Dang
• Yen Dang
• Maud Darger, BSN, RN, PA-STUDENT

• Orthopedic Physical Therapist in Forest Grove, OR
• Providers in Forest Grove, OR by specialty
• Orthopedic Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.