Provider Demographics
NPI:1720351323
Name:PEDORTHIC SERVICES, INC.
Entity Type:Organization
Organization Name:PEDORTHIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CATANIA
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:503-992-6366
Mailing Address - Street 1:10240 SW NIMBUS AVE
Mailing Address - Street 2:SUITE L5
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-992-6366
Mailing Address - Fax:503-524-8397
Practice Address - Street 1:10240 SW NIMBUS AVE
Practice Address - Street 2:SUITE L5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-992-6366
Practice Address - Fax:503-524-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNO LICENCSE REQUIRED224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty