Active NPI
Bruce Kenneth Mangers, PT
- Physical Therapist
- Corvallis, OR
National Provider Identifier
1821205642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2459
- Practice address
- 815 NW 9TH St
Suite180
Corvallis, OR 97330-6173 - Phone
- (541) 768-5157
- Fax
- (541) 768-5080
- NPI assigned
- May 17, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2459 | OR | Primary |
Addresses
Primary practice location
815 NW 9TH St
Suite180
Corvallis, OR 97330-6173
Mailing address
815 NW 9TH St
Suite180
Corvallis, OR 97330-6173
Phone (541) 768-5157
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 |
|---|---|---|---|
| 2459 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1821205642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 NW 9TH ST",
"address_2": "SUITE180",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973306173",
"telephone_number": "541-768-5157",
"fax_number": "541-768-5080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 NW 9TH ST",
"address_2": "SUITE180",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973306173",
"telephone_number": "541-768-5157",
"fax_number": "541-768-5080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGERS",
"first_name": "BRUCE",
"middle_name": "KENNETH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "2459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.