MEDICARE: COTTAGE GROVE PHYSICAL THERAPY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407847999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTTAGE GROVE PHYSICAL THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 654
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-0028
Country	:	US
Telephone Number	:	541-767-2750
Fax Number	:	541-767-2751

Provider Business Practice Location Address
First Line	:	303 E MAIN ST
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-2032
Country	:	US
Telephone Number	:	541-767-2750
Fax Number	:	541-767-2751

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER LYNN WOOD
Credential	:
Telephone Number	:	541-767-2750

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/22/2020

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