Healthcare Provider Details

I. General information

NPI: 1275129777
Provider Name (Legal Business Name): STARGAIT PORTLAND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 SW NIMBUS AVE
BEAVERTON OR
97008-6444
US

IV. Provider business mailing address

5054 SE INA AVE
PORTLAND OR
97267-5927
US

V. Phone/Fax

Practice location:
  • Phone: 971-219-4899
  • Fax: 855-840-8203
Mailing address:
  • Phone: 971-219-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA ZIELINSKI
Title or Position: COO
Credential: PT, DPT
Phone: 971-219-4899