C Thomas Provenzano, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2227 Issued in OR

Practice address

9260 SE Stark St
Suite B
Portland, OR 97216-1675

Phone

(503) 255-1500

Fax

(503) 255-1560

NPI assigned

Nov 10, 2005

Last updated

Jul 13, 2026By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Cascade 205 Orthopedic and Sports Physical Therapy, PC

  • Preferred Provider Organization
  • Portland, OR
  • NPI 1356348106
  NPD (past)
• Kula Chiropractic Sports & Wellness Center, Inc

  dba Kula Chiropractic Sports & Wellness

  • Sports Physician Chiropractor
  • White Salmon, WA
  • NPI 1912390113
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1548241995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6809 NE HANCOCK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972135343",
            "telephone_number": "503-280-7346",
            "fax_number": "503-255-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9260 SE STARK ST",
            "address_2": "SUITE B",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972161675",
            "telephone_number": "503-255-1500",
            "fax_number": "503-255-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "C",
        "middle_name": "THOMAS",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "2227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prov Health Sys-Or Shared Sys Div (Providence Employee Clinic - The Plaza)
• Prov Health Sys-Or Shared-SVS Div (Providence Health Education)
• Lauren Ashley Provansal, PSS, CADC-R
• Carol Anne Provencal
• Lyndsay Provencio, PT
• Johanna Christine Provenzano
• Robert Provenzano, MD
• Providence
• Providence Elderplace
• Providence Health & Service - Oregon (Providence ElderPlace - Portland)

• Physical Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.