Provider Demographics
NPI:1568702272
Name:ELITE ORTHOPAEDIC PHYSICAL THERAPY AND SPORTS PERFORMANCE
Entity Type:Organization
Organization Name:ELITE ORTHOPAEDIC PHYSICAL THERAPY AND SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVERTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:971-241-2294
Mailing Address - Street 1:2540 NE SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-5958
Mailing Address - Country:US
Mailing Address - Phone:971-241-2294
Mailing Address - Fax:
Practice Address - Street 1:2540 NE SARATOGA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5958
Practice Address - Country:US
Practice Address - Phone:971-241-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1568702272OtherNPI
OR5952OtherOREGON PHYSICAL THERAPY LICENSE