Provider Demographics
NPI:1699477810
Name:CCR THERAPIES LLC
Entity type:Organization
Organization Name:CCR THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-233-5410
Mailing Address - Street 1:2947 NW WILD MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5297
Mailing Address - Country:US
Mailing Address - Phone:720-233-5410
Mailing Address - Fax:
Practice Address - Street 1:2947 NW WILD MEADOW DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5297
Practice Address - Country:US
Practice Address - Phone:720-233-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty