Trevor Thomas Pettigrew, PT, DPT

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

61193 Issued in OR

Practice address

507 NE 47TH Ave
Portland, OR 97213-2236

Phone

(503) 215-6488

NPI assigned

Aug 14, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1245710847",
    "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": "972132236",
            "telephone_number": "503-215-6488"
        },
        {
            "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": "972132236",
            "telephone_number": "503-215-6488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIGREW",
        "first_name": "TREVOR",
        "middle_name": "THOMAS",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-14",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "61193",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "OR",
            "license": "61193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Pettet, CADC1
• Hannah Pettey
• Thomas David Pettey, BS IN PT
• Larston Petticord, MS, LPC
• Roman Tobias Pettigrew, DO
• Da'Nae Lynett Pettis
• Davonte Pettis
• Kersti Pettit-Kekel, OT
• Brandon James Pettit, BA
• Jody L Pettit, MD

• Sports Physical Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Sports Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.