Glen Raymond Akers, PT
Individual provider Active NPI Physical Therapist · Gresham, OR
NPI 1477519874 · NPPES record last updated Nov 13, 2008
Key facts
- NPI
- 1477519874
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5023 (OR)
- Practice address
- 25500 SE Stark St
Suite 103
Gresham, OR 97030-3331 - Phone
- (503) 328-0222
- Fax
- (503) 328-0223
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- New Proactive LLC
Practice addresses (Care Compare)
25500 SE Stark St
Suite 103
Gresham, OR 97030-8327
Phone (503) 263-6786
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060328000340 | OR | Practitioner - Physical Therapist in Private Practice | 3274541537 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5023 | OR | MD | Naturopath |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Proactive Orthopedic and Sports Physical Therapy of Gresham LLC | Current |
Accepting new patients | |
| New Proactive LLC | Physical Therapist | Current |
Accepting new patients |
| Omnis Omnia Inc. | Past |
Accepting new patients |
Locations
308 N Ivy St
Canby, OR 97013
Phone (503) 263-6786
1480 NE Village St
Fairview, OR 97024
Phone (503) 489-1174
25500 SE Stark St
Ste 103
Gresham, OR 97030
Phone (503) 263-6786
1630 Beavercreek Rd
Ste A
Oregon City, OR 97045
Phone (503) 607-0047
450 NW Greenwood Ave
Redmond, OR 97756
Phone (541) 923-0410
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5023 | OR | Yes |
Addresses
Primary practice location
25500 SE Stark St
Suite 103
Gresham, OR 97030-3331
Mailing address
PO Box 52194
Dept Code 961
Phoenix, AZ 85072-2194
Phone (503) 328-0222
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.