Stacey Leann Abosamra, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

65347 Issued in OR

Practice address

2330 NW Flanders St Ste G1
Portland, OR 97210-3441

Phone

(503) 223-1856

NPI assigned

Jun 24, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chehalem Physical Therapy IncGroup PAC ID 2769455344, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chehalem Physical Therapy, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Newberg, OR
  • NPI 1164497111

  OR

  Medicare reassignment Care Compare group NPD
• KJB Consulting Corporation

  • Physical Therapy Clinic/Center
  • Portland, OR
  • NPI 1497172373

  OR, Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1063256071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 NW FLANDERS ST STE G1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103441",
            "telephone_number": "503-223-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 NW FLANDERS ST STE G1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103441",
            "telephone_number": "503-223-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOSAMRA",
        "first_name": "STACEY",
        "middle_name": "LEANN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tzaphkiel Ablossi
• Kandice Abney
• Rebecca Abney, D.O.
• Ghayda Aboasha, RBT
• Olubunmi Aborisade, DNP
• Mouammar Mohamed Abouagila
• Emad Salam Aboujaoude, PA
• About Family Health LLC
• Allison Lynn Abraham, D.O.
• Allyson Abraham

• All providers in Portland, OR
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.