Provider Demographics
NPI:1528595477
Name:VALENTI, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:VALENTI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8836
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:4437 SE CESAR E CHAVEZ BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3581
Practice Address - Country:US
Practice Address - Phone:503-774-3585
Practice Address - Fax:503-774-3602
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500725337Medicaid
ORR194585OtherMEDICARE
ORP01904118OtherRR MEDICARE
ORR194586OtherMEDICARE