Provider Demographics
NPI:1548724677
Name:SPORTSCARE INTEGRATIVE PHYSICAL THERAPY
Entity type:Organization
Organization Name:SPORTSCARE INTEGRATIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMIKO
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:SALDIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-402-1076
Mailing Address - Street 1:24076 SE STARK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3376
Mailing Address - Country:US
Mailing Address - Phone:503-491-1666
Mailing Address - Fax:503-491-1667
Practice Address - Street 1:24076 SE STARK ST STE 200
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3376
Practice Address - Country:US
Practice Address - Phone:503-491-1666
Practice Address - Fax:503-491-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500747250Medicaid