Provider Demographics
NPI:1356348106
Name:CASCADE 205 ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:CASCADE 205 ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:503-255-1500
Mailing Address - Street 1:9260 SE STARK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1640
Mailing Address - Country:US
Mailing Address - Phone:503-255-1500
Mailing Address - Fax:503-255-1560
Practice Address - Street 1:9260 SE STARK ST
Practice Address - Street 2:SUITE B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-1640
Practice Address - Country:US
Practice Address - Phone:503-255-1500
Practice Address - Fax:503-255-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2319305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297214Medicaid
OR297214Medicaid