Individual provider Active NPI

Faerynn Tilgner, PT

  • Physical Therapist
  • Canby, OR
National Provider Identifier
1609606540
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
65287 Issued in OR
Practice address
365 S Redwood St
Canby, OR 97013-2405
Phone
(503) 651-2020
NPI assigned
Aug 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 65287 OR Primary

Addresses

Primary practice location

365 S Redwood St
Canby, OR 97013-2405

Mailing address

10974 SW Durham Rd Apt 56
Tigard, OR 97224-4350
Phone (971) 301-2538

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240902000196 OR Practitioner - Physical Therapist in Private Practice 6002355278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Lake Physical Therapy and Rehab LPGroup PAC ID 4082853825, 39 clinicians

Practice addresses (Care Compare)

15755 SW Sequoia Pkwy
Suite 101
Tigard, OR 97224-7166
Phone (503) 639-8284

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Lake Physical Therapy and Rehab LP Physical Therapist CurrentSince Sep 9, 2024 Accepting new patients

Locations

365 S Redwood St
Canby, OR 97013
Phone (503) 266-4263

101 S State St
Ste 4200
Lake Oswego, OR 97034
Phone (503) 636-3025

4606 SE Boardman Ave
Portland, OR 97267
Phone (503) 353-9776

15755 SW Sequoia Pkwy
Ste 101
Tigard, OR 97224
Phone (503) 639-8284

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1609606540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10974 SW DURHAM RD APT 56",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972244350",
            "telephone_number": "971-301-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 S REDWOOD ST",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970132405",
            "telephone_number": "503-651-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILGNER",
        "first_name": "FAERYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canby, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.