Healthcare Provider Details

I. General information

NPI: 1831706308
Provider Name (Legal Business Name): OSPREY PHYSICAL THERAPY AND SPORTS MEDICINE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 SE 9TH ST STE 5
BEND OR
97702-2265
US

IV. Provider business mailing address

558 SE 9TH ST STE 5
BEND OR
97702-2265
US

V. Phone/Fax

Practice location:
  • Phone: 541-647-7332
  • Fax: 541-640-5541
Mailing address:
  • Phone: 541-647-7332
  • Fax: 541-640-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROL ROEDER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 541-647-7332