Provider Demographics
NPI:1689657769
Name:CASCADE GRESHAM PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CASCADE GRESHAM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-669-2500
Mailing Address - Street 1:19201 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5227
Mailing Address - Country:US
Mailing Address - Phone:503-669-2500
Mailing Address - Fax:503-661-4113
Practice Address - Street 1:19201 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5227
Practice Address - Country:US
Practice Address - Phone:503-669-2500
Practice Address - Fax:503-661-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
114904Medicare ID - Type UnspecifiedGROUP NUMBER