1396979761 NPI number — PINNACLE PHYSICAL THERAPY LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396979761 NPI number — PINNACLE PHYSICAL THERAPY LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE PHYSICAL THERAPY LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396979761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4025 CHERRY AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEIZER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97303-4859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-390-9009
Provider Business Mailing Address Fax Number:
503-393-0834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 WEST ELLENDALE AVE.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97338-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-623-2433
Provider Business Practice Location Address Fax Number:
503-623-2196
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ISMAIL
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
209-576-0888

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com