Provider Demographics
NPI:1679185862
Name:DECIPHER PHYSIO, LLC
Entity Type:Organization
Organization Name:DECIPHER PHYSIO, LLC
Other - Org Name:ORCHARD PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-728-3559
Mailing Address - Street 1:1129 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4413
Mailing Address - Country:US
Mailing Address - Phone:541-728-3559
Mailing Address - Fax:
Practice Address - Street 1:1129 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4413
Practice Address - Country:US
Practice Address - Phone:541-728-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437381514OtherNPI