NPIMap

Organization Active NPI

Pivotal Physical Therapy, LLC

  • Physical Therapist
  • Sherwood, OR
National Provider Identifier
1063469773
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4428 Issued in OR
Legal business name
PIVOTAL PHYSICAL THERAPY, LLC
Practice address
15899 SW Baler Way
Sherwood, OR 97140-8833
Phone
(503) 625-2217
Fax
(503) 925-1469
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Justin David Harle, P.T.NPI 1578511325
Title
Owner
Phone
(503) 625-2217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 4428 OR Primary

Addresses

Primary practice location

15899 SW Baler Way
Sherwood, OR 97140-8833

Mailing address

15899 SW Baler Way
Sherwood, OR 97140-8833
Phone (503) 625-2217

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1063469773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15899 SW BALER WAY",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971408833",
            "telephone_number": "503-625-2217",
            "fax_number": "503-925-1469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15899 SW BALER WAY",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971408833",
            "telephone_number": "503-625-2217",
            "fax_number": "503-925-1469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIVOTAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HARLE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-625-2217",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "4428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherwood, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.