Individual provider Active NPI

Jody McClenny

  • Physical Therapy Assistant
  • Portland, OR
National Provider Identifier
1124947965
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
9890 Issued in OR
Practice address
507 NE 47TH Ave
Portland, OR 97213-2205
Phone
(503) 215-6488
Fax
(503) 215-6485
NPI assigned
Jul 14, 2026
Sex
Unspecified or another gender identity
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 9890 OR Primary

Addresses

Primary practice location

507 NE 47TH Ave
Portland, OR 97213-2205

Mailing address

507 NE 47TH Ave
Portland, OR 97213-2205

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

NPI Registry JSON

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

{
    "created_epoch": "1783987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1124947965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 NE 47TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 NE 47TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132205",
            "telephone_number": "503-215-6488",
            "fax_number": "503-215-6485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLENNY",
        "first_name": "JODY",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2026-07-14",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "9890",
            "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 14, 2026; 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.