Healthcare Provider Details

I. General information

NPI: 1356324560
Provider Name (Legal Business Name): JOE J PATERNO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 NE BROADWAY ST
PORTLAND OR
97232-1811
US

IV. Provider business mailing address

2444 NE 49TH AVE
PORTLAND OR
97213-1928
US

V. Phone/Fax

Practice location:
  • Phone: 503-287-6636
  • Fax: 503-287-4044
Mailing address:
  • Phone: 503-284-9288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1187
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: