# CENTRAL CASCADES PHYSICAL THERAPY

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

## Provider details

- **NPI number:** 1245234285
- **Authorized official:** GROVER DEAN COCKRUM P.T. (C.E.O)
- **Authorized official phone:** (541) 576-2110

## Contact information

- **Practice address:** 87520 BAY ROAD, CHRISTMAS VALLEY, OR 97641-0001
- **Practice address phone:** (541) 576-2110
- **Practice address fax:** (541) 598-0489
- **Mailing address:** PO BOX 4520, SUNRIVER, OR 97707-1520
- **Mailing address phone:** (541) 576-2110
- **Mailing address fax:** (541) 598-0489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 1385 | OR | Yes |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 05/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 269080 | — | OR |
| 01 | — | 808366001 | REGENCE BLUECROSS/BLUESHI | OR |