Longevity Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LONGEVITY PHYSICAL THERAPY

Practice address

1655 SE Umatilla St
Portland, OR 97202-7212

Phone

(636) 288-0641

NPI assigned

Jul 25, 2023

Organization subpart

No

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

Authorized official

Name

Jennifer Sellers, PTNPI 1669715074

Title

Managing Member/Owner

Phone

(636) 288-0641

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.

• Jennifer Sellers, PT, DPT

  • Physical Therapist
  • Vancouver, WA
  • NPI 1669715074

  OR

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1690243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690243200000",
    "number": "1912688748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 SE UMATILLA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027212",
            "telephone_number": "636-288-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 SE UMATILLA ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027212",
            "telephone_number": "636-288-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-25",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "636-288-0641",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tallina Long
• Terra Marie Long, LMT
• Therese Long
• William Broughton Long III, MD
• Christopher Jay Longaker, M.D.
• Ritchie Longoria III, PHARMD
• Becky Longrie
• Leela Jackie Longson, L.AC., M.AC.OM
• Jodi Lynn Longueil, PHARMD
• Kanoughn Longwell, MSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.