Organization
CENTRAL CASCADES PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GROVER DEAN COCKRUM P.T. (C.E.O)
(541) 576-2110
Entity
Organization
Contact information
Practice address
87520 BAY ROAD, CHRISTMAS VALLEY, OR 97641-0001
(541) 576-2110
(541) 598-0489
Mailing address
PO BOX 4520, SUNRIVER, OR 97707-1520
(541) 576-2110
(541) 598-0489
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1385
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269080
—
OR
01
—
808366001
REGENCE BLUECROSS/BLUESHI
OR
Enumeration date
06/08/2005
Last updated
05/23/2013
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