Individual ProviderCharlo Brandon CrumpackerPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1424 Molalla Ave, Oregon City, OR 97045-4004(503) 744-4916(423) 682-8840PECOS EnrollmentBased on the most recent information from CMS, provider Charlo Brandon Crumpacker does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:05 AM.Profile DetailsProvider ID1003461823Provider TypeIndividualFull NameCrumpacker, Charlo BrandonCredentialPT, DPTGenderMaleSole ProprietorNoEnumeration Date8/8/2019Last Updated3/9/2021Contact InformationPractice LocationPractice Address1424 Molalla Ave, Oregon City, OR 97045-4004Phone(503) 744-4916FaxUnlisted FaxMailing LocationMailing Address1200 Corporate Dr, Hoover, AL 35242-2941Phone(423) 682-8840FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted IssuerCode2251X0800XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense63405Oregon