Provider Demographics
NPI:1225165996
Name:WESTSIDE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WESTSIDE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-466-9800
Mailing Address - Street 1:16265 NW CORNELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4909
Mailing Address - Country:US
Mailing Address - Phone:503-466-9800
Mailing Address - Fax:503-466-9817
Practice Address - Street 1:16265 NW CORNELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4909
Practice Address - Country:US
Practice Address - Phone:503-466-9800
Practice Address - Fax:503-466-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR136790Medicare PIN