MEDICARE: DECIPHER PHYSIO, LLC

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437381514	OTHER		NPI

General Provider Information

NPI Number	:	1679185862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECIPHER PHYSIO, LLC

Provider Business Mailing Address
First Line	:	1129 NE 12TH ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4413
Country	:	US
Telephone Number	:	541-728-3559
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 NE 12TH ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4413
Country	:	US
Telephone Number	:	541-728-3559
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	BREANNA CRAWFORD
Credential	:	DPT
Telephone Number	:	541-728-3559

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	10/26/2020

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Directions to “DECIPHER PHYSIO, LLC ” Practice Location

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