# CASCADE REHABILITATION ASSOCIATES, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174567952
- **Authorized official:** MR. SAMUEL EDWARD BLACKWELL JR. MS PT (PRESIDENT)
- **Authorized official phone:** (541) 923-1436

## Contact information

- **Practice address:** 735 SW 11TH ST, STE 103, REDMOND, OR 97756-2649
- **Practice address phone:** (541) 923-1436
- **Practice address fax:** (541) 923-1467
- **Mailing address:** 735 SW 11TH ST, STE 103, REDMOND, OR 97756-9592
- **Mailing address phone:** (541) 923-1436
- **Mailing address fax:** (541) 923-1467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 0908 | OR | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 08/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 05-4082000 | BLUE CROSS BLUE SHIELD | OR |
| 05 | — | 233502 | — | OR |