Active NPI
Mark Lawrence Pietrok, A.T.C.
- Athletic Trainer
- Portland, OR
National Provider Identifier
1861580540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-AT-125479
- Practice address
- 0615 SW Palatine Hill Rd
Portland, OR 97219-7879 - Phone
- (503) 768-7065
- Fax
- (503) 768-7058
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT-AT-125479 | OR | Primary |
Addresses
Primary practice location
0615 SW Palatine Hill Rd
Portland, OR 97219-7879
Mailing address
11149 SW Matzen Dr
Wilsonville, OR 97070-8574
Phone (503) 682-1622
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-AT-125479 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861580540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11149 SW MATZEN DR",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970708574",
"telephone_number": "503-682-1622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "0615 SW PALATINE HILL RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972197879",
"telephone_number": "503-768-7065",
"fax_number": "503-768-7058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIETROK",
"first_name": "MARK",
"middle_name": "LAWRENCE",
"name_prefix": "Mr.",
"credential": "A.T.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-125479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.