NPIMap

Organization Active NPI

Corvallis Sport and Spine Physical Therapy Inc

  • Physical Therapist
  • Corvallis, OR
National Provider Identifier
1841388170
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CORVALLIS SPORT AND SPINE PHYSICAL THERAPY INC
Practice address
2635 NW Rolling Green Dr
Corvallis, OR 97330-3519
Phone
(541) 753-4246
Fax
(541) 757-0545
NPI assigned
Oct 11, 2006
Last updated
Jan 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Authorized official

Name
Karla A Moore
Title
Practice Administrator
Phone
(541) 753-4246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X OR Primary

Addresses

Primary practice location

2635 NW Rolling Green Dr
Corvallis, OR 97330-3519

Mailing address

2635 NW Rolling Green Dr
Corvallis, OR 97330-3519
Phone (541) 753-4246

Other identifiers 1

IdentifierTypeStateIssuer
831588000OtherBCBS

Other names 1

  • Corvallis Sport and Spine PT Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041216001051 OR Part B Supplier - Clinic/Group Practice 2961469333 Receives reassigned benefits from 16 practitioners
Practice locations: Albany, OR; Philomath, OR; Corvallis, OR

National Provider Directory

National Provider Directory
Tax ID family
Corvallis Sport Spine Phys2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

613 Hickory St NW
Albany, OR 97321
Phone (541) 753-4246

613 Hickory St NW
Ste 120
Albany, OR 97321

2101 NW Professional Dr
Ste 2
Corvallis, OR 97330
Phone (541) 752-0545

2635 NW Rolling Green Dr
Corvallis, OR 97330
Phone (541) 752-0545

1529 Main St
Philomath, OR 97370
Phone (541) 929-3333

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769558400000",
    "number": "1841388170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2635 NW ROLLING GREEN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303519",
            "telephone_number": "541-753-4246",
            "fax_number": "541-757-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 NW ROLLING GREEN DR",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303519",
            "telephone_number": "541-753-4246",
            "fax_number": "541-757-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORVALLIS SPORT AND SPINE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "541-753-4246"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "831588000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corvallis Sport and Spine PT",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Corvallis Sport and Spine PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.