Active NPI
Leo A.H. Sergeant, PT, COMT
- Physical Therapist
- Portland, OR
National Provider Identifier
1396805719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4953
- Practice address
- 3025 N Vancouver Ave
Portland, OR 97227-1542 - Phone
- (503) 413-3879
- Fax
- (503) 413-4379
- NPI assigned
- Dec 8, 2006
- Last updated
- Sep 16, 2014
- Sex
- Male
- 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 | 4953 | OR | Primary |
Addresses
Primary practice location
3025 N Vancouver Ave
Portland, OR 97227-1542
Mailing address
300 N Graham St
Suite 430
Portland, OR 97227-1683
Phone (503) 413-1500
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 |
|---|---|---|---|
| 4953 | OR | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Emanuel Hospital & Health Center | Past | Accepting new patients | |
| Legacy Clinics LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinic/Center
- Portland, OR
- NPI 1902827272
-
dba Apothecary at Emanuel Hospital
- Community/Retail Pharmacy
- Portland, OR
- NPI 1417977976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410825600000",
"number": "1396805719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST",
"address_2": "SUITE 430",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-413-1500",
"fax_number": "503-413-1501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3025 N VANCOUVER AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271542",
"telephone_number": "503-413-3879",
"fax_number": "503-413-4379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERGEANT",
"first_name": "LEO",
"middle_name": "A.H.",
"name_prefix": "Mr.",
"credential": "PT, COMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-08",
"last_updated": "2014-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "4953",
"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 Sep 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.