NPIMap

Organization Active NPI

Pelvic Wellness Center of Salem

  • Physical Therapist
  • Salem, OR
National Provider Identifier
1689130270
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PELVIC WELLNESS CENTER OF SALEM
Practice address
1655 Capitol St NE
Salem, OR 97301-7845
Phone
(503) 551-1099
Fax
(503) 364-1376
NPI assigned
Feb 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Shannon Forrestall, PTNPI 1598743999
Title
Owner
Phone
(503) 551-1099

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1655 Capitol St NE
Salem, OR 97301-7845

Mailing address

1655 Capitol St NE
Salem, OR 97301-7845

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190501000618 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9133461718 Receives reassigned benefits from 8 practitioners
Practice locations: Salem, OR

National Provider Directory

National Provider Directory

Locations

1655 Capitol St NE
Salem, OR 97301
Phone (503) 877-2815

Practitioners & affiliated clinicians

Practitioners 8

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": "1550534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1689130270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 CAPITOL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973017845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 CAPITOL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973017845",
            "telephone_number": "503-551-1099",
            "fax_number": "503-364-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELVIC WELLNESS CENTER OF SALEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-19",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "FORRESTALL",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-551-1099",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.