Provider Demographics
NPI:1639566698
Name:PDX BODYWORKS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PDX BODYWORKS PHYSICAL THERAPY
Other - Org Name:NORTHWEST INJURY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, BA
Authorized Official - Phone:971-678-7422
Mailing Address - Street 1:1818 NE MLK BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3976
Mailing Address - Country:US
Mailing Address - Phone:971-678-7422
Mailing Address - Fax:
Practice Address - Street 1:1818 NE MLK BLVD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3976
Practice Address - Country:US
Practice Address - Phone:503-206-8988
Practice Address - Fax:503-206-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
OR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy