NPIMap

Organization Active NPI

TSL Well LLC

  • Physical Therapist
  • Lake Oswego, OR
National Provider Identifier
1730915083
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TSL WELL LLC
Practice address
3900 Kruse Way PL
Lake Oswego, OR 97035-2512
Phone
(503) 635-7000
NPI assigned
Sep 12, 2024
Last updated
Sep 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Mr. Fancho Fee Stubblefield Jr.
Title
Owner
Phone
(503) 435-2323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3900 Kruse Way PL
Lake Oswego, OR 97035-2512

Mailing address

3330 SE Three Mile LN
McMinnville, OR 97128-6232
Phone (503) 435-2323

Other names 1

  • TSL Well LLC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241204004210 OR Part B Supplier - Clinic/Group Practice 0345776050 Receives reassigned benefits from 12 practitioners
Practice locations: Milwaukie, OR; Sherwood, OR; Medford, OR; Lake Oswego, OR; Hillsboro, OR; Happy Valley, OR; Eugene, OR; Beaverton, OR

National Provider Directory

National Provider Directory

Locations

822 Golf View Dr
Medford, OR 97504
Phone (541) 774-1822

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1730915083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3330 SE THREE MILE LN",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971286232",
            "telephone_number": "503-435-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 KRUSE WAY PL",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352512",
            "telephone_number": "503-635-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TSL WELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "STUBBLEFIELD",
        "authorized_official_first_name": "FANCHO",
        "authorized_official_middle_name": "FEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-435-2323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TSL Well LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.