Timothy Max Wallenburg, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

65063 Issued in OR

Practice address

17420 Meinig Ave
Sandy, OR 97055-8068

Phone

(503) 427-0118

Fax

(503) 427-0279

NPI assigned

Nov 20, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

New Proactive LLCGroup PAC ID 7315218708, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Proactive LLC

  • Physical Therapy Clinic/Center
  • Oregon City, OR
  • NPI 1396273199

  OR

  Medicare reassignment Care Compare group
• Physiotherapy Associates Inc.

  • Physical Therapy Clinic/Center
  • Happy Valley, OR
  • NPI 1083339618
  NPD
• Physiotherapy Associates, Inc.

  • Physical Therapy Clinic/Center
  • Tigard, OR
  • NPI 1184362337
  NPD
• Physiotherapy Associates Inc

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1720039902
  NPD

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

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1497358451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SOLAR DR STE 150",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930360680",
            "telephone_number": "805-604-1924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17420 MEINIG AVE",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970558068",
            "telephone_number": "503-427-0118",
            "fax_number": "503-427-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENBURG",
        "first_name": "TIMOTHY",
        "middle_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-20",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erika Mae Unruh
• Stefani Vandenberg, CHW
• Trisha Tan Villanueva, PHARMD
• Cristen Elissa Visconty, LMT, CVT
• Walgreen Co
• Kelley Ruth Ward, PA-C
• Jing Wei, FNP
• David Wenzel, PH.D.
• Hollis Maclean Wenzel, LMFT
• Janet C West, MD

• All providers in Sandy, OR
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.