Healthcare Provider Details

I. General information

NPI: 1235485053
Provider Name (Legal Business Name): NICK ADAM GEORGE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 SE CIRCUIT DR STE 140
HILLSBORO OR
97123-1961
US

IV. Provider business mailing address

7305 SE CIRCUIT DR STE 140
HILLSBORO OR
97123-1961
US

V. Phone/Fax

Practice location:
  • Phone: 971-501-4905
  • Fax:
Mailing address:
  • Phone: 971-501-4905
  • Fax: 503-215-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4066
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: