Pro Motion Physical Therapy of Bend

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

04366 Issued in OR

Legal business name

PRO MOTION PHYSICAL THERAPY OF BEND

Doing business as

Promotion Physical Therapy

Practice address

1693 SW Chandler Ave
Suite 140
Bend, OR 97702-3236

Phone

(541) 390-0523

Fax

(541) 787-4383

NPI assigned

Mar 9, 2016

Organization subpart

No

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

Authorized official

Name

Mr. William Blake Matlock, B.S., MSPTNPI 1013228295

Title

Owner

Phone

(541) 390-0523

Specialties & licenses 1

Addresses

Other names 1

• Promotion Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Tax ID family

Pro Motion Physical 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.

• Promotion Physical Therapy

  • Physical Therapy Clinic/Center
  • Bend, OR
  • NPI 1548681547
  NPD tax ID

Locations

Practitioners 2

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

• William Blake Matlock, MSPT

  • Physical Therapist
  • Bend, OR
  • NPI 1013228295
  Medicare reassignment Authorized official
• Conor Matthews, DPT

  • Orthopedic Physical Therapist
  • Bend, OR
  • NPI 1457021842
  NPD (past)

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1639530249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977090072",
            "telephone_number": "541-390-0523",
            "fax_number": "541-787-4383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1693 SW CHANDLER AVE",
            "address_2": "SUITE 140",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023236",
            "telephone_number": "541-390-0523",
            "fax_number": "541-787-4383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO MOTION PHYSICAL THERAPY OF BEND",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-09",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "MATLOCK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-390-0523",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S., MSPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "04366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Promotion Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kara Marie Prier, M.D.
• Paige Nicole Priestley
• Elizabeth Prieto
• John Vincent Prignano, PH.D.
• Jason Prinster, PH.D.
• Proactive Health LLC
• Kristen Prochaska, MA, LPC
• Kristyn Renee Prockish, PMHNP
• Professionals Choice Medical Supplies and Special Transport
• Program Design Concepts, Inc

• Orthopedic Physical Therapist in Bend, OR
• Providers in Bend, OR by specialty
• Orthopedic Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.