Sportscare Physical Therapy @ Cornell, LLC
Organization Active NPI Physical Therapy Clinic/Center · Beaverton, OR
NPI 1649534793 · NPPES record last updated Jul 3, 2012
Key facts
- NPI
- 1649534793
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 1660 (OR)
- Legal business name
- SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC
- Practice address
- 15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006 - Phone
- (503) 257-9881
- NPI assigned
- Jul 3, 2012
- Organization subpart
- No
Authorized official
- Name
- Joseph John Fricke, PT
- Title
- Managing Partner
- Phone
- (503) 257-9881
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 5
Practitioners 48
-
Barbara Adelson, OTR/L
-
Olivia Nicole Bartlett, DPT, PT
-
David Brockman, PT, DPT
-
Patrick Clinton, PT
-
Kristin Devoto, P.T.
-
Rosie Endow, OTR/L
-
Madison Constance Fief, OTR/L
-
Ryan Douglas Glover, OTR/L, CHT
-
Victoria Elizabeth Guinn, DPT, PT
-
Tyler Ichiki, OTR/L
-
Jacob Alan Schneller, DPT
-
Joseph Shannon, DPT
-
Anne Spiliotis, OT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120917000315 | OR | Part B Supplier - Clinic/Group Practice | 7517115579 |
Receives reassigned benefits from 43 practitioners Practice locations: Tigard, OR; Sandy, OR; Salem, OR; Portland, OR; Clackamas, OR; Gresham, OR; Beaverton, OR |
National Provider Directory
- Tax ID family
- Sportscare Physical Therapy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 1660 | OR | Yes |
Addresses
Primary practice location
15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006
Mailing address
15390 NW Cornell Rd.
Suite 230
Beaverton, OR 97006
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 072538 | Medicaid | OR |
Other providers in Beaverton, OR
- Nancy Jane Spiegel
- Jessica A Spies
- Samantha Spies
- Jillian Elizabeth Spink
- Sportscare Physical Therapy @ Cornell, LLC
- Joel Spravzoff
- Sandra Springer
- Rebekah Springs
- Springwell Homecare Agency LLC
- John Srere
All providers in Beaverton, OR · Physical Therapy Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.