NPIMap

Organization Active NPI

Mitchell Physical Therapy Inc

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1073657391
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1766 Issued in OR
Legal business name
MITCHELL PHYSICAL THERAPY INC
Practice address
5212 SE 52ND Ave
Portland, OR 97206-5629
Phone
(503) 777-1983
NPI assigned
Feb 19, 2007
Last updated
Jul 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Authorized official

Name
Mr. Stephen MitchellNPI 1538197991
Title
Owner
Phone
(503) 777-1983

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 Therapist 225100000X 1766 OR Primary

Addresses

Primary practice location

5212 SE 52ND Ave
Portland, OR 97206-5629

Mailing address

5212 SE 52ND Ave
Portland, OR 97206-5629
Phone (503) 777-1983

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050628000422 OR Part B Supplier - Clinic/Group Practice 2860437027 Receives reassigned benefits from 6 practitioners
Practice locations: Milwaukie, OR; Portland, OR

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1073657391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5212 SE 52ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972065629",
            "telephone_number": "503-777-1983",
            "fax_number": "503-771-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5212 SE 52ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972065629",
            "telephone_number": "503-777-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-777-1983",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "1766",
            "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 Jul 7, 2020; 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.