Provider Demographics
NPI:1184322992
Name:CYPERT, COLTON DEWAYNE (DPT)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:DEWAYNE
Last Name:CYPERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 BOONE RD SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9391
Mailing Address - Country:US
Mailing Address - Phone:503-585-5131
Mailing Address - Fax:
Practice Address - Street 1:2521 BOONE RD SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9391
Practice Address - Country:US
Practice Address - Phone:503-585-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist