Stout Performance and Physical Therapy LLC

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

Legal business name

STOUT PERFORMANCE AND PHYSICAL THERAPY LLC

Practice address

710 NE Holladay St # 150
Portland, OR 97232-2168

Phone

(503) 542-2744

NPI assigned

Dec 23, 2024

Organization subpart

No

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

Authorized official

Name

Jake Stout

Title

Owner/Provider

Phone

(503) 949-1727

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacob Stout

  • Sports Physical Therapist
  • Portland, OR
  • NPI 1851790570

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1734912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1790593739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 NE HOLLADAY ST # 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 NE HOLLADAY ST # 150",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322168",
            "telephone_number": "503-542-2744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOUT PERFORMANCE AND PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-23",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-22",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "503-949-1727"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Stoudt, MA
• Mark Andrew Stouffer, LPCI
• Danielle Madison Stough
• Vasiliki D Stoumbos, MD
• Zoey Eleni Stoumbos
• Erin Leigh Stout
• Jacob Stout
• Kaeley Stout
• Maggie May Stout
• Ron Stout, CPO02785

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.