Active NPI
Christopher Ullom, PTA
- Physical Therapy Assistant
- Milwaukie, OR
National Provider Identifier
1326592171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- P160661758
- Practice address
- 4560 SE International Way
Ste 100
Milwaukie, OR 97222-4628 - Phone
- (206) 824-0600
- NPI assigned
- Aug 10, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | P160661758 | WA | Primary |
Addresses
Primary practice location
4560 SE International Way
Ste 100
Milwaukie, OR 97222-4628
Mailing address
4529 44TH Ave SW
Apt 301
Seattle, WA 98116-4907
Phone (301) 305-2690
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P160661758 | WA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1326592171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4529 44TH AVE SW",
"address_2": "APT 301",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981164907",
"telephone_number": "301-305-2690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "STE 100",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972224628",
"telephone_number": "206-824-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLOM",
"first_name": "CHRISTOPHER",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-08-10",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WA",
"license": "P160661758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.