Douglas Noland Bennett, DPT, CSCS

Individual provider Active NPI Physical Therapist · Wilsonville, OR

NPI 1770083446 · NPPES record last updated Feb 19, 2018

Key facts

NPI
1770083446
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
62607 (OR)
Practice address
25030 SW Parkway Ave Ste 100
Wilsonville, OR 97070-9816
Phone
(503) 582-1073
Fax
(503) 582-1093
NPI assigned
Feb 19, 2018
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Motion, PLLC Physical Therapist Past
since Jul 28, 2024
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 62607 OR Yes

Addresses

Primary practice location

25030 SW Parkway Ave Ste 100
Wilsonville, OR 97070-9816

Mailing address

13525 SW Aragon St
Beaverton, OR 97005-0820
Phone (971) 570-6818

Other providers in Wilsonville, OR

All providers in Wilsonville, OR · Physical Therapist in Oregon

Sources for this page

Verify at the official NPI Registry.