NPIMap

Organization Active NPI

Active Edge Physical Therapy & Sports Medicine P.C.

  • Physical Therapy Clinic/Center
  • West Linn, OR
National Provider Identifier
1730324336
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ACTIVE EDGE PHYSICAL THERAPY & SPORTS MEDICINE P.C.
Practice address
2020 8TH Ave Ste D
West Linn, OR 97068-4657
Phone
(503) 387-5449
Fax
(503) 342-6846
NPI assigned
Dec 10, 2008
Last updated
May 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Mr. Daniel C. Morlan, PT
Title
President
Phone
(503) 675-0267

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary
Specialist 174400000X 4568 OR

Addresses

Primary practice location

2020 8TH Ave Ste D
West Linn, OR 97068-4657

Mailing address

2020 8TH Ave Ste D
West Linn, OR 97068-4657
Phone (503) 387-5449

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090108000131 OR Part B Supplier - Clinic/Group Practice 7113080714 Receives reassigned benefits from 18 practitioners
Practice locations: West Linn, OR

National Provider Directory

National Provider Directory
Tax ID family
Active Edge PT Sports Med3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2020 8th Ave
Ste D
West Linn, OR 97068
Phone (503) 387-5449

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1730324336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE D",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-387-5449",
            "fax_number": "503-342-6846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE D",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-387-5449",
            "fax_number": "503-342-6846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE EDGE PHYSICAL THERAPY & SPORTS MEDICINE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "MORLAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-675-0267",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "4568",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Linn, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.