Healthcare Provider Details

I. General information

NPI: 1548656143
Provider Name (Legal Business Name): NW PHYSICAL THERAPY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 SW MOHAWK ST
TUALATIN OR
97062-8121
US

IV. Provider business mailing address

7616 SW MOHAWK ST
TUALATIN OR
97062-8121
US

V. Phone/Fax

Practice location:
  • Phone: 503-379-1525
  • Fax: 503-575-7150
Mailing address:
  • Phone: 503-379-1525
  • Fax: 503-575-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DOMINICK, DOMINICK
Title or Position: OWNER/MEMBER
Credential: PT
Phone: 503-379-1525