Healthcare Provider Details

I. General information

NPI: 1326110313
Provider Name (Legal Business Name): ERHARDT PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51385 SW OLD PORTLAND RD SUITE E
SCAPPOOSE OR
97056-4061
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 503-543-7768
  • Fax: 503-543-7772
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier029022
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierDF4105
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAIL ROAD MEDICARE

VIII. Authorized Official

Name: WADE A MEYER
Title or Position: VP CHIEF COMPLIANCE OFFICER
Credential:
Phone: 630-296-2222