Provider Demographics
NPI:1548656143
Name:NW PHYSICAL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:NW PHYSICAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DOMINICK,
Authorized Official - Last Name:DOMINICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-379-1525
Mailing Address - Street 1:7616 SW MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8121
Mailing Address - Country:US
Mailing Address - Phone:503-379-1525
Mailing Address - Fax:503-575-7150
Practice Address - Street 1:7616 SW MOHAWK ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8121
Practice Address - Country:US
Practice Address - Phone:503-379-1525
Practice Address - Fax:503-575-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty