Healthcare Provider Details

I. General information

NPI: 1194940189
Provider Name (Legal Business Name): CASCADE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 DANA DR STE E
REDDING CA
96003-4036
US

IV. Provider business mailing address

1007 DANA DR STE E
REDDING CA
96003-4036
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-5188
  • Fax: 530-222-5167
Mailing address:
  • Phone: 530-222-5188
  • Fax: 530-222-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ERICK KIMBALL GOSS
Title or Position: PHYSICAL THERAPIST
Credential: D.P.T.
Phone: 530-222-5188