Individual provider Active NPI

Kristen Tervo, PT

  • Physical Therapist
  • Tigard, OR
National Provider Identifier
1063474641
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
63073 Issued in OR
Practice address
12123 SW 69TH Ave
Tigard, OR 97223-8514
Phone
(717) 087-6009
NPI assigned
Apr 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 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 8072 OH
Physical Therapist 225100000X 63073 OR Primary

Addresses

Primary practice location

12123 SW 69TH Ave
Tigard, OR 97223-8514

Mailing address

12123 SW 69TH Ave
Tigard, OR 97223-8514
Phone (971) 708-7600

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
8072OHMDPhysical Therapist
63073ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabclinics SPT, Inc. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1063474641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12123 SW 69TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238514",
            "telephone_number": "971-708-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12123 SW 69TH AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238514",
            "telephone_number": "717-087-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERVO",
        "first_name": "KRISTEN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "8072",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "63073",
            "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 Jan 10, 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.