Healthcare Provider Details

I. General information

NPI: 1225165996
Provider Name (Legal Business Name): WESTSIDE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16265 NW CORNELL RD SUITE 100
BEAVERTON OR
97006-4909
US

IV. Provider business mailing address

16265 NW CORNELL RD SUITE 100
BEAVERTON OR
97006-4909
US

V. Phone/Fax

Practice location:
  • Phone: 503-466-9800
  • Fax: 503-466-9817
Mailing address:
  • Phone: 503-466-9800
  • Fax: 503-466-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES JOSEPH CENOVA
Title or Position: PRESIDENT
Credential: PT
Phone: 503-466-9800