Provider Demographics
NPI:1407905854
Name:CASCADE PHYSICAL THERAPY OF GRANTS PASS LLC
Entity Type:Organization
Organization Name:CASCADE PHYSICAL THERAPY OF GRANTS PASS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-955-0940
Mailing Address - Street 1:544 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-955-0940
Mailing Address - Fax:541-955-5233
Practice Address - Street 1:544 UNION AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-955-0940
Practice Address - Fax:541-955-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4392225100000X
OR1086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
865489000OtherBCBS
865489000OtherBCBS