Provider Demographics
NPI:1578918140
Name:CASCADE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CASCADE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:530-222-5188
Mailing Address - Street 1:1007 DANA DR STE E
Mailing Address - Street 2:ADDRESS 2
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4036
Mailing Address - Country:US
Mailing Address - Phone:530-222-5188
Mailing Address - Fax:
Practice Address - Street 1:1007 DANA DR STE E
Practice Address - Street 2:ADDRESS 2
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4036
Practice Address - Country:US
Practice Address - Phone:530-222-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26399261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0263990Medicaid
CA0PT263990Medicare UPIN