Brian T Sundahl, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5367 Issued in OR

Practice address

19856 SE Highway 212
Damascus, OR 97089-5743

Phone

(417) 559-2627

Fax

(503) 386-2745

NPI assigned

Jun 16, 2006

Sex

Male

Sole proprietor

No

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.

• Endeavor Physical Therapy, Inc.

  • Physical Therapist
  • Damascus, OR
  • NPI 1457577553

  OR

  Medicare reassignment Care Compare group Authorized official
• Olympic Sports and Spine Rehabilitation PS

  • Physical Therapist
  • Puyallup, WA
  • NPI 1558310375
  NPD (past)

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Endeavor Physical Therapy Inc 2 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in OR, MO2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 6, 2022.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1790729952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "372 SOUTH BROADWAY",
            "city": "ESTACADA",
            "state": "OR",
            "postal_code": "97023",
            "telephone_number": "503-630-5314",
            "fax_number": "503-630-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19856 SE HIGHWAY 212",
            "city": "DAMASCUS",
            "state": "OR",
            "postal_code": "970895743",
            "telephone_number": "417-559-2627",
            "fax_number": "503-386-2745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDAHL",
        "first_name": "BRIAN",
        "middle_name": "T",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008548",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "5367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "5743SU",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "151355",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8347015",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I CRIME VICTIMS PROGRAM",
            "identifier": "8930584",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Damascus, OR
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.