Active NPI
Jerry Lee Cain II, PT, MPT
- Physical Therapist
- Portland, OR
National Provider Identifier
1114130366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3251
- Practice address
- 4805 NE Glisan St
Portland, OR 97213-2933 - Phone
- (503) 215-3078
- Fax
- (503) 215-6394
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3251 | OR | Primary |
Addresses
Primary practice location
4805 NE Glisan St
Portland, OR 97213-2933
Mailing address
2435 NE 27TH Ave
Portland, OR 97212-4852
Phone (503) 234-7668
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3251 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114130366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2435 NE 27TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972124852",
"telephone_number": "503-234-7668",
"fax_number": "503-215-6394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-3078",
"fax_number": "503-215-6394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAIN",
"first_name": "JERRY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "PT, MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "3251",
"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 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.