NPIMap

Organization Active NPI

Broadway Physical Therapy & Sports Rehab LLC

  • Specialist
  • Portland, OR
National Provider Identifier
1326185950
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2270 Issued in OR
Legal business name
BROADWAY PHYSICAL THERAPY & SPORTS REHAB LLC
Practice address
3016 NE Broadway St
Portland, OR 97232-1811
Phone
(503) 287-6636
Fax
(503) 287-4044
NPI assigned
Jan 31, 2007
Last updated
Feb 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Authorized official

Name
Ellen R GroverNPI 1578546040
Title
Owner
Phone
(503) 287-6636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 2270 OR Primary

Addresses

Primary practice location

3016 NE Broadway St
Portland, OR 97232-1811

Mailing address

3016 NE Broadway St
Portland, OR 97232-1811
Phone (503) 287-6636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001123 OR Part B Supplier - Clinic/Group Practice 4183610611 Receives reassigned benefits from 6 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

3016 NE Broadway St
Portland, OR 97232
Phone (503) 287-6636

Practitioners & affiliated clinicians

Practitioners 12

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1326185950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321811",
            "telephone_number": "503-287-6636",
            "fax_number": "503-287-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3016 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321811",
            "telephone_number": "503-287-6636",
            "fax_number": "503-287-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY PHYSICAL THERAPY & SPORTS REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-287-6636"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "2270",
            "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 Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.