Organization
CASCADE REHABILITATION ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL EDWARD BLACKWELL JR. MS PT (PRESIDENT)
(541) 923-1436
Entity
Organization
Contact information
Practice address
735 SW 11TH ST, STE 103, REDMOND, OR 97756-2649
(541) 923-1436
(541) 923-1467
Mailing address
735 SW 11TH ST, STE 103, REDMOND, OR 97756-9592
(541) 923-1436
(541) 923-1467
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0908
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-4082000
BLUE CROSS BLUE SHIELD
OR
05
—
233502
—
OR
Enumeration date
06/15/2006
Last updated
08/20/2008
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