Provider Demographics
NPI:1649507617
Name:OREGON PHYSICAL THERAPY & SPORTS
Entity type:Organization
Organization Name:OREGON PHYSICAL THERAPY & SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCARLETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-252-4100
Mailing Address - Street 1:3620 NE 122ND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1365
Mailing Address - Country:US
Mailing Address - Phone:503-252-4100
Mailing Address - Fax:503-252-3390
Practice Address - Street 1:3620 NE 122ND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1365
Practice Address - Country:US
Practice Address - Phone:503-252-4100
Practice Address - Fax:503-252-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy