Active NPI
Linda Kay Harmon-Provost, PT
- Pediatric Physical Therapist
- Tualatin, OR
National Provider Identifier
1457689044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT3258
- Practice address
- 19250 SW 65TH Ave
Medical Plaza #1 Suite 125
Tualatin, OR 97062-7452 - Phone
- (503) 692-1670
- Fax
- (503) 692-1669
- NPI assigned
- Nov 19, 2009
- Last updated
- Nov 19, 2009
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT3258 | OR | Primary |
Addresses
Primary practice location
19250 SW 65TH Ave
Medical Plaza #1 Suite 125
Tualatin, OR 97062-7452
Mailing address
PO Box 4037
Portland, OR 97208-4037
Phone (503) 413-4048
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3258 | Other | OR | OREGON PT LICENSE |
| PENDING | Medicaid | OR |
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 |
|---|---|---|---|
| PT3258 | OR | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Meridian Park Hospital | Past | Accepting new patients | |
| Legacy Meridian Park Pediatric Rehab | 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.
-
- Hospitalist Physician
- Tualatin, OR
- NPI 1023305034
-
- Children's Rehabilitation Hospital
- Tualatin, OR
- NPI 1801122593
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258588800000",
"number": "1457689044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4037",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972084037",
"telephone_number": "503-413-4048",
"fax_number": "503-413-2910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19250 SW 65TH AVE",
"address_2": "MEDICAL PLAZA #1 SUITE 125",
"city": "TUALATIN",
"state": "OR",
"postal_code": "970627452",
"telephone_number": "503-692-1670",
"fax_number": "503-692-1669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARMON-PROVOST",
"first_name": "LINDA",
"middle_name": "KAY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-11-19",
"last_updated": "2009-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "OR",
"license": "PT3258",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON PT LICENSE",
"identifier": "3258",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tualatin, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.