Active NPI
Shira Racoosin
- Physical Therapist
- Portland, OR
National Provider Identifier
1366054363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 27969
- Practice address
- 1327 SE Tacoma St Unit 122
Portland, OR 97202-6639 - Phone
- (971) 361-9442
- NPI assigned
- Aug 20, 2020
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 27969 | MD | Primary |
Addresses
Primary practice location
1327 SE Tacoma St Unit 122
Portland, OR 97202-6639
Mailing address
6919 Fairfax Rd
Bethesda, MD 20814-1230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27969 | Other | MD | LICENSE NUMBER |
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 |
|---|---|---|---|
| 27969 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597881600000",
"number": "1366054363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6919 FAIRFAX RD",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208141230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1327 SE TACOMA ST UNIT 122",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972026639",
"telephone_number": "971-361-9442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RACOOSIN",
"first_name": "SHIRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-20",
"last_updated": "2020-08-20",
"certification_date": "2020-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "27969",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "27969",
"state": "MD"
}
],
"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 Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.