Healthcare Provider Details

I. General information

NPI: 1790694354
Provider Name (Legal Business Name): COURTLETE SPORTS REHAB & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 SW NIMBUS AVE
BEAVERTON OR
97008-6438
US

IV. Provider business mailing address

13420 SW 6TH ST
BEAVERTON OR
97005-3871
US

V. Phone/Fax

Practice location:
  • Phone: 971-318-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHENYONG XIANG
Title or Position: MANAGER
Credential: PT, DPT, OCS
Phone: 971-318-2444