Kristoffer De Leon – Physical Therapist in Dallas, OR

Key facts

NPI: 1821828849
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 65442 (OR)
Practice address: 210 W Ellendale Ave Ste 100
Dallas, OR 97338-1790
Phone: (503) 623-2433
NPI assigned: Aug 5, 2024
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.

Northwest Rehabilitation Associates, Inc. Physical Therapy Clinic/Center · West Salem, OR · NPI 1972505790

Medicare reassignment Care Compare group NPD OR · PHYSICAL THERAPIST

Medicare Care Compare profile

Specialty: Physical Therapist in Private Practice
Education: Other, 2024
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Northwest Rehabilitation Associates Inc (32 clinicians)

Practice addresses (Care Compare)

210 W Ellendale Ave
Suite 100
Dallas, OR 97338-1790
Phone (503) 623-2433

Medicare participation

Medicare fee-for-service enrollment: Enrolled in OR

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20241212000525	OR	Practitioner - Physical Therapist in Private Practice	1658807706	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Northwest Rehabilitation Associates, Inc.	Physical Therapist	Current since Aug 22, 2024	Accepting new patients

Locations

210 W Ellendale Ave
Ste 100
Dallas, OR 97338
Phone (503) 623-2433

3270 Liberty Rd S
Salem, OR 97302
Phone (503) 371-0779

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	65442	OR	Yes

Addresses

Primary practice location

210 W Ellendale Ave Ste 100
Dallas, OR 97338-1790

Mailing address

210 W Ellendale Ave Ste 100
Dallas, OR 97338-1790
Phone (503) 623-2433

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 8, 2024.

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1821828849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W ELLENDALE AVE STE 100",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381790",
            "telephone_number": "503-623-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W ELLENDALE AVE STE 100",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381790",
            "telephone_number": "503-623-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LEON",
        "first_name": "KRISTOFFER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

All providers in Dallas, OR · Physical Therapist in Oregon

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.