Healthcare Provider Details

I. General information

NPI: 1760675615
Provider Name (Legal Business Name): PINNACLE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 CHERRY AVE NE
KEIZER OR
97303-4859
US

IV. Provider business mailing address

4025 CHERRY AVE NE
KEIZER OR
97303-4859
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-9009
  • Fax: 503-393-0834
Mailing address:
  • Phone: 503-390-9009
  • Fax: 503-393-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4634
License Number StateOR

VIII. Authorized Official

Name: BOBBY ISMAIL
Title or Position: CEO
Credential:
Phone: 209-576-0710