Sportscare Physical Therapy @ Cornell, LLC
Organization Active NPI Durable Medical Equipment & Medical Supplies · Clackamas, OR
NPI 1972362879 · NPPES record last updated Mar 14, 2024
Key facts
- NPI
- 1972362879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC
- Practice address
- 10121 SE Sunnyside Rd Ste 208
Clackamas, OR 97015-5750 - Phone
- (503) 794-1003
- NPI assigned
- Mar 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Penny Tacker
- Title
- Regulatory Specialist
- Phone
- (713) 297-7052
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 5
Practitioners 36
-
Barbara Adelson, OTR/L
-
Olivia Nicole Bartlett, DPT, PT
-
Elizabeth Biesemeyer, DPT, PT
-
David Brockman, PT, DPT
-
Patrick Clinton, PT
-
Kristin Devoto, P.T.
-
Rosie Endow, OTR/L
-
Madison Constance Fief, OTR/L
-
Ryan Douglas Glover, OTR/L, CHT
-
Victoria Elizabeth Guinn, DPT, PT
-
Tyler Ichiki, OTR/L
-
Allison Elizabeth Pratt, OTR/L
-
Jacob Alan Schneller, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240530002080 | OR | DME Supplier - Independently-Practicing Occupational Therapist | 7517115579 | Practice locations: Clackamas, OR |
National Provider Directory
- Tax ID family
- Sportscare Physical Therapy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
10121 SE Sunnyside Rd Ste 208
Clackamas, OR 97015-5750
Mailing address
10121 SE Sunnyside Rd Ste 208
Clackamas, OR 97015-5750
Phone (503) 794-1003
Other providers in Clackamas, OR
- Katelyn M Spain
- Sylvia Sanaia Sparrow
- Speak Up Speech Therapy, LLC
- Amy Ruth Spencer
- Sandra J Spooner
- Breanna Elizabeth Sreter
- St Lukes Eye Clinic PC
- St Lukes Eye Clinic PC
- Matthew G St. Peter
- Michelle Travers Stacey
All providers in Clackamas, OR · Durable Medical Equipment & Medical Supplies in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.