NPIMap

Organization Active NPI

Childrens Intensive Therapy Northwest

  • Pediatric Physical Therapist
  • Portland, OR
National Provider Identifier
1477886232
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
4970 Issued in OR
Legal business name
CHILDRENS INTENSIVE THERAPY NORTHWEST
Practice address
7203 SE Raymond St
Portland, OR 97206-4323
Phone
(503) 895-1320
Fax
(503) 296-2319
NPI assigned
Sep 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Darren David Brault
Title
Owner
Phone
(971) 570-5043

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251P0200X 4970 OR Primary
Pediatric Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251P0200X 5680 OR

Addresses

Primary practice location

7203 SE Raymond St
Portland, OR 97206-4323

Mailing address

12948 SE Winston Rd
Damascus, OR 97089-7606
Phone (971) 570-5043

National Provider Directory

National Provider Directory
Tax ID family
Children'S Intensive Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7203 SE Raymond St
Portland, OR 97206
Phone (503) 859-1320

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1477886232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12948 SE WINSTON RD",
            "city": "DAMASCUS",
            "state": "OR",
            "postal_code": "970897606",
            "telephone_number": "971-570-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7203 SE RAYMOND ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972064323",
            "telephone_number": "503-895-1320",
            "fax_number": "503-296-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS INTENSIVE THERAPY NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-11",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "BRAULT",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-570-5043",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "OR",
            "license": "4970",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": "OR",
            "license": "5680",
            "primary": false
        }
    ],
    "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 Jul 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.