Grant Andrew Bortnem, DPT
Individual provider Active NPI Physical Therapist · Salem, OR
NPI 1861628331 · NPPES record last updated Mar 17, 2017
Key facts
- NPI
- 1861628331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 05964 (OR)
- Practice address
- 3270 Liberty Rd S
Salem, OR 97302 - Phone
- (503) 371-0779
- Fax
- (503) 371-0886
- NPI assigned
- Jun 10, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northwest Rehabilitation Associates Inc
Practice addresses (Care Compare)
3270 Liberty Rd S
Salem, OR 97302-4560
Phone (503) 371-0779
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090810000062 | OR | Practitioner - Physical Therapist in Private Practice | 7315090313 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5964 | OR | MD | Rehabilitation Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Rehabilitation Associates, Inc. | Physical Therapist | Current |
Accepting new patients |
| Andrew Physical Therapy, Inc | Current |
Accepting new patients |
Locations
210 W Ellendale Ave
Ste 100
Dallas, OR 97338
Phone (503) 623-2433
2025 NE Baker St
Ste A
McMinnville, OR 97128
Phone (503) 435-1900
3270 Liberty Rd S
Salem, OR 97302
Phone (503) 371-0779
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5964 | OR | |
| Physical Therapist | 225100000X | 05964 | OR | Yes |
Addresses
Primary practice location
3270 Liberty Rd S
Salem, OR 97302
Mailing address
3270 Liberty Rd S
Salem, OR 97302
Phone (503) 371-0779
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500622178 | Medicaid | OR |
Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2017. 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.