Individual provider Active NPI

John Zdor, DPT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1053830513
Registry record updated Nov 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
63977 Issued in OR
Practice address
12400 NW Cornell Rd Ste 200
Portland, OR 97229-5689
Phone
(503) 643-1737
NPI assigned
Sep 15, 2017
Last updated
Nov 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60788710 WA
Physical Therapist 225100000X 63977 OR Primary

Addresses

Primary practice location

12400 NW Cornell Rd Ste 200
Portland, OR 97229-5689

Mailing address

9115 SW Oleson Rd Ste 205
Portland, OR 97223-6877
Phone (503) 245-2420

Other practice location 1

9115 SW Oleson Rd Ste 206
Portland, OR 97223-6877
Phone (503) 245-2420

Other practice location 2

223 E Reserve St Ste 104
Vancouver, WA 98661-3875
Phone (360) 573-2266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63977ORMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668384000000",
    "number": "1053830513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9115 SW OLESON RD STE 205",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236877",
            "telephone_number": "503-245-2420",
            "fax_number": "360-954-5259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 NW CORNELL RD STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972295689",
            "telephone_number": "503-643-1737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9115 SW Oleson Rd Ste 206",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972236877",
            "country_code": "US",
            "telephone_number": "503-245-2420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "223 E Reserve St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986613875",
            "country_code": "US",
            "telephone_number": "360-573-2266",
            "fax_number": "360-573-1502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZDOR",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-15",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60788710",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.