NPIMap

Organization Active NPI

Pacific Neuro Therapy

Doing business as Apex Performance Wellness & Rehab

  • Physical Therapist
  • Tigard, OR
National Provider Identifier
1316394083
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PACIFIC NEURO THERAPY
Doing business as
Apex Performance Wellness & Rehab
Practice address
11105 SW Greenburg Rd
Tigard, OR 97223-5446
Phone
(971) 294-2669
Fax
(503) 746-6609
NPI assigned
May 23, 2016
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Kellen Mastrud
Title
Co-Owner & President
Phone
(971) 294-2669

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

11105 SW Greenburg Rd
Tigard, OR 97223-5446

Mailing address

11105 SW Greenburg Rd
Tigard, OR 97223-5446
Phone (971) 294-2669

Other names 1

  • Apex Performance Wellness & Rehab Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kellen@apexpwr.com Direct

National Provider Directory

National Provider Directory

Locations

10831 SW Cascade Ave
Ste 103
Tigard, OR 97223

11105 SW Greenburg Rd
Tigard, OR 97223
Phone (971) 294-2669

Practitioners & affiliated clinicians

Practitioners 7

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": "1463961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1316394083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11105 SW GREENBURG RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972235446",
            "telephone_number": "971-294-2669",
            "fax_number": "503-746-6609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11105 SW GREENBURG RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972235446",
            "telephone_number": "971-294-2669",
            "fax_number": "503-746-6609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NEURO THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-23",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "MASTRUD",
        "authorized_official_first_name": "KELLEN",
        "authorized_official_title_or_position": "CO-OWNER & PRESIDENT",
        "authorized_official_telephone_number": "971-294-2669"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kellen@apexpwr.com",
            "affiliation": "N",
            "endpointDescription": "Company Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11105 SW Greenburg Rd",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972235446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Apex Performance Wellness & Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.