Pettygrove Physical Therpay Associates LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PETTYGROVE PHYSICAL THERPAY ASSOCIATES LLC

Practice address

1515 NW 18TH Ave
Suite 400
Portland, OR 97123

Phone

(503) 228-1306

Fax

(503) 228-1307

NPI assigned

Feb 5, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly A Stallings

Title

Office Manager

Phone

(503) 228-1306

Specialties & licenses 1

Addresses

Other names 1

• Pettygrove Physcial Therapy & Sports Rehabilitation Other name

Locations

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750420063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 NW 18TH AVE",
            "address_2": "SUITE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97123",
            "telephone_number": "503-228-1306",
            "fax_number": "503-228-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 NW 18TH AVE",
            "address_2": "SUITE 400",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97123",
            "telephone_number": "503-228-1306",
            "fax_number": "503-228-1307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTYGROVE PHYSICAL THERPAY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STALLINGS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-228-1306",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pettygrove Physcial Therapy & Sports Rehabilitation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Nicole Petty
• Michelle Elizabeth Petty
• Randi Michelle Petty, RDH
• Terry Lee Petty, DC
• Pettygrove Dental LLC
• Ethan David Pettyjohn, LPC
• Karen E Petzing, D.C.
• Lara Michelle Pevzner, M.A., LPC
• Brittany Pew, MS, OTR/L
• James A Peykanu, MD

• Physical Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.