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General NPI Number Information
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NPI Number | 1649534793
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Entity Type | Organization
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Legal Business Name | SPORTSCARE PHYSICAL THERAPY @ CORNELL, LLC
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 15390 NW CORNELL RD. SUITE 230
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City | BEAVERTON
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State | OR
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Zip | 97006
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Country | US
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Telephone | 503-257-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 15390 NW CORNELL RD. SUITE 230
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City | BEAVERTON
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State | OR
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Zip | 97006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JOSEPH JOHN FRICKE
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Credential | PT
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Telephone | 503-257-9881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1660
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License Number State | OR
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