NPIMap

Organization Active NPI

PDX Bodyworks Physical Therapy

  • Health Service Clinic/Center
  • Portland, OR
National Provider Identifier
1639566698
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
PDX BODYWORKS PHYSICAL THERAPY
Practice address
1818 NE MLK Blvd Ste C
Portland, OR 97212-3976
Phone
(503) 206-8988
Fax
(503) 206-6143
NPI assigned
Apr 16, 2015
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Shawn P. Cooney, PTA, BANPI 1770619595
Title
Co-Owner
Phone
(971) 678-7422

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary
Physical Therapy Clinic/Center 261QP2000X OR

Addresses

Primary practice location

1818 NE MLK Blvd Ste C
Portland, OR 97212-3976

Mailing address

1818 NE MLK Blvd Ste C
Portland, OR 97212-3976
Phone (971) 678-7422

Other names 1

  • Northwest Injury Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181114000424 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5799039566 Receives reassigned benefits from 3 practitioners
Practice locations: Portland, OR

National Provider Directory

National Provider Directory

Locations

1818 NE Mlk Jr Blvd
Ste C
Portland, OR 97212
Phone (503) 206-8988

4016 NE Fremont St
Portland, OR 97212
Phone (971) 678-7422

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1639566698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 NE MLK BLVD STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123976",
            "telephone_number": "971-678-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 NE MLK BLVD STE C",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123976",
            "telephone_number": "503-206-8988",
            "fax_number": "503-206-6143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PDX BODYWORKS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "COONEY",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "971-678-7422",
        "authorized_official_credential": "PTA, BA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Injury Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jan 11, 2024; 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.