Active NPI
Gaelen Watt, DPT
- Physical Therapist
- Clackamas, OR
National Provider Identifier
1124412366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 63280
- Practice address
- 10121 SE Sunnyside Rd
#208
Clackamas, OR 97015 - Phone
- (503) 794-0103
- Fax
- (503) 794-0104
- NPI assigned
- Mar 25, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physical Therapist | 225100000X | 63280 | OR | Primary |
Addresses
Primary practice location
10121 SE Sunnyside Rd
#208
Clackamas, OR 97015
Mailing address
10121 SE Sunnyside Rd
#208
Clackamas, OR 97015
Phone (503) 794-0103
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568764800000",
"number": "1124412366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10121 SE SUNNYSIDE RD",
"address_2": "#208",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "97015",
"telephone_number": "503-794-0103",
"fax_number": "503-794-0104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10121 SE SUNNYSIDE RD",
"address_2": "#208",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "97015",
"telephone_number": "503-794-0103",
"fax_number": "503-794-0104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATT",
"first_name": "GAELEN",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-25",
"last_updated": "2019-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "63280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.