Provider Demographics
NPI:1902249022
Name:ROCKWOOD ORTHOPAEDIC & SPORTS PHYSICAL THERAPY CLINIC, PC
Entity Type:Organization
Organization Name:ROCKWOOD ORTHOPAEDIC & SPORTS PHYSICAL THERAPY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BONICA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-254-2652
Mailing Address - Street 1:3800 SW CEDAR HILLS BLVD
Mailing Address - Street 2:SUITE 280A
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2035
Mailing Address - Country:US
Mailing Address - Phone:503-254-2652
Mailing Address - Fax:503-254-2814
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:SUITE 280A
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2035
Practice Address - Country:US
Practice Address - Phone:503-254-2652
Practice Address - Fax:503-254-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1053261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy