NPIMap

Organization Active NPI

Connect Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Tigard, OR
National Provider Identifier
1023386257
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1330 Issued in OR
Legal business name
CONNECT PHYSICAL THERAPY, LLC
Practice address
12540 SW 68TH Ave
Tigard, OR 97223-8597
Phone
(503) 974-9078
Fax
(503) 974-9083
NPI assigned
Dec 2, 2011
Last updated
May 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diane O. ShifferNPI 1598708919
Title
Owner
Phone
(503) 974-9078

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1330 OR Primary

Addresses

Primary practice location

12540 SW 68TH Ave
Tigard, OR 97223-8597

Mailing address

12540 SW 68TH Ave
Tigard, OR 97223-8597
Phone (503) 974-9078

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130828000626 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9537302245 Receives reassigned benefits from 8 practitioners
Practice locations: Tigard, OR

National Provider Directory

National Provider Directory

Locations

17120 Pilkington Rd
Lake Oswego, OR 97035
Phone (503) 619-1150

12540 SW 68th Ave
Tigard, OR 97223
Phone (503) 974-9078

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1023386257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12540 SW 68TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238597",
            "telephone_number": "503-974-9078",
            "fax_number": "503-974-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12540 SW 68TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238597",
            "telephone_number": "503-974-9078",
            "fax_number": "503-974-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2023-05-30",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "SHIFFER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-974-9078"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "1330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.