Provider Demographics
NPI:1497820575
Name:HOOD RIVER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOOD RIVER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-386-2441
Mailing Address - Street 1:2690 MAY ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9786
Mailing Address - Country:US
Mailing Address - Phone:541-386-2441
Mailing Address - Fax:541-386-5869
Practice Address - Street 1:2690 MAY ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9786
Practice Address - Country:US
Practice Address - Phone:541-386-2441
Practice Address - Fax:541-386-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR054101Medicaid
ORR0000WCPFYMedicare ID - Type Unspecified
OR0613540001Medicare NSC