Provider Demographics
NPI:1134299951
Name:J AND D PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:J AND D PHYSICAL THERAPY SERVICES
Other - Org Name:REBOUND ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-797-9585
Mailing Address - Street 1:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5571
Mailing Address - Country:US
Mailing Address - Phone:503-797-9585
Mailing Address - Fax:503-797-0650
Practice Address - Street 1:ONE CENTER COURT
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2104
Practice Address - Country:US
Practice Address - Phone:503-797-9585
Practice Address - Fax:503-797-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3362225100000X, 261QP2000X
WAPT00009469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862967Medicare PIN