MEDICARE: NORTH LAKE PHYSICAL THERAPY AND REHAB LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1316383201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH LAKE PHYSICAL THERAPY AND REHAB LP

Provider Business Mailing Address
First Line	:	101 S STATE ST STE 4200
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3977
Country	:	US
Telephone Number	:	503-636-3028
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S STATE ST STE 4200
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-3977
Country	:	US
Telephone Number	:	503-636-3028
Fax Number	:

Authorized Official
Title or Position	:	VP, AUTHORIZED OFFICIAL
Name	:	RICHARD BINSTEIN
Credential	:	JD
Telephone Number	:	713-297-7000

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	09/30/2021

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