Unknown Individual – Physical Therapist, NPI 1558304790

Unknown Individual is a healthcare provider. based in Tualatin, Oregon. specializing in Physical Therapist. They hold a License No. PT0851 (OR). The NPI Number for Unknown Individual is 1558304790

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1558304790
Phone
(971) 204-0600
Address
6464 SW BORLAND RD STE B5
Deactivation Date
19 June 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1972 (54 years ago)
PAC ID
0345294112
Professional Enrollment ID
I20050304000576
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Southwest Borland Road, Tualatin, Metro, Clackamas County, Oregon, 97035, United States

    TUALATIN, OR 970628859

    Phone: (971) 204-0600

    Fax: (971) 204-0602

    Type: Location

  • C, 6464, Southwest Borland Road, Tualatin, Clackamas County, Oregon, 97062, United States

    STE B5

    TUALATIN, OR 970628859

    Phone: (971) 204-0600

    Fax: (971) 204-0602

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97062)

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Provider's Procedures

Unknown Individual performs procedures in Physical Therapist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICAL THERAPYOR97140Manual (physical) therapy techniques to 1 or more regions, each 15 minutes83159

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1558304790.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Physical Therapist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Tualatin, Oregon in the same public data insurers reference.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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