MR. JUSTIN ROBERT THIBEAULT (NPI# 1376579631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376579631 |
| Entity Type | Individual |
| Full Name | MR. JUSTIN ROBERT THIBEAULT |
| Credential | PA-C |
| Practice Address |
1515 Nw 18th Ave 3rd Floor Portland OR 97209-2516 |
| Mailing Address |
200 Ne Mother Joseph Pl Ste 210 Vancouver WA 98664-3295 |
| Practice Telephone | 5032248399 |
| Practice Fax Number | 5032245661 |
| Mailing Telephone | 5032248399 |
| Mailing Fax Number | 5032245661 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2016-07-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA153476 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1515 NW 18TH AVE 3RD FLOOR |
| City | PORTLAND |
| State | OR |
| Zip Code | 97209-2516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245230952 | Leo Francis Quinn Jr. | Physical Therapist | 1515 Nw 18th Ave, Ste 400, Portland, OR 97209-2515 | 2005-07-22 |
| 1316497928 | Orthopedic & Sports Medicine Center of Or LLC | Physician Assistant | 1515 Nw 18th Ave, #300, Portland, OR 97209-2516 | 2016-10-06 |
| 1588076954 | Rose City Physical Therapy Associates, LLC | Clinic/Center | 1515 Nw 18th Ave, Suite 400, Portland, OR 97209-2516 | 2014-05-20 |
| 1851645121 | Suzanne Chi | Acupuncturist | 1515 Nw 18th Ave, Suite 400, Portland, OR 97209-2516 | 2012-11-07 |
| 1740538115 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 1515 Nw 18th Ave, Suite 100, Portland, OR 97209-2516 | 2012-08-16 |
| 1245482280 | Northwest Ambulatory Surgery Center LLC | Clinic/Center | 1515 Nw 18th Ave, Ste 200, Portland, OR 97209-2516 | 2008-10-22 |
| 1225293285 | Emily C Nguyen | Orthopaedic Surgery | 1515 Nw 18th Ave, Ste 300, Portland, OR 97209-2539 | 2008-07-18 |
| 1750420063 | Pettygrove Physical Therpay Associates LLC | Physical Therapist | 1515 Nw 18th Ave, Suite 400, Portland, OR 97123 | 2007-02-05 |
| 1376600049 | Barry A Jacoshenk | Physician Assistant | 1515 Nw 18th Ave, Suite 300, Portland, OR 97209-2516 | 2007-01-02 |
| 1235179656 | Derek Edward Lamprecht | Orthopaedic Surgery | 1515 Nw 18th Ave, Suite 300, Portland, OR 97209-2515 | 2006-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1619599636 | Rivers Way Training Clinic | Community/Behavioral Health | 2049 Nw Hoyt, Portland, OR 97209 | 2020-05-13 |
| 1518590538 | Julie Kay Igarta | Registered Nurse | 140 Northwest 14th Avenue, Portland, OR 97209 | 2020-02-18 |
| 1407492002 | Oregon Injection Clinic | Clinic/Center | 1500 Nw Lovejoy, 106, Portland, OR 97209 | 2019-11-19 |
| 1487202883 | Ann Tesora | Massage Therapist | 1320 Northwest 20th Avenue, Portland, OR 97209 | 2019-08-28 |
| 1972160455 | Vincent Martin | Massage Therapist | 210 Sw 17th Avenue, Portland, OR 97209 | 2019-05-21 |
| 1154896546 | Jennifer Marie Dodd | Social Worker | 1722 Nw Raleigh St Spc 412, Portland, OR 97209 | 2018-10-11 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1326408394 | Jennifer Blain | Counselor | 324 Nw Davis, Portland, OR 97209 | 2016-03-03 |
| 1275993255 | Lauren Dodson | Licensed Practical Nurse | 324 Nw Davis St, Portland, OR 97209 | 2016-03-03 |
| Find all providers in zip 97209 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1396250122 | Saron Theresa Sufuentes | Physician Assistant | 578 Nw Marlborough Ave, Portland, OR 97210-3104 | 2017-12-01 |
| 1952775520 | Lauren Govier | Physician Assistant | 501 N Graham St Ste 415, Portland, OR 97227-2006 | 2015-11-19 |
| 1619346368 | Ryan Mcmahon | Physician Assistant | 3415 Ne 20th Ave, Portland, OR 97212-2416 | 2015-09-23 |
| 1881090033 | Sanja Bukarac | Physician Assistant | 20 Buca Run, Portland, ME 04103-1427 | 2014-11-17 |
| 1194130716 | Nicole Lessard | Physician Assistant | 27 Bramhall St, Portland, ME 04102 | 2014-06-23 |
| 1528499910 | Elan Kennedy | Physician Assistant | 3181 Sw Sam Jackson Park Rd., Mail Code L353, Ohsu, Division of Cardiothoracic Surgery, Portland, OR 97239 | 2013-12-10 |
| 1013161405 | Lorraine Walburga Gohman | Physician Assistant | 9155 Sw Barnes Rd Ste 440, Portland, OR 97225-6631 | 2008-11-11 |
| 1841472065 | Mandy Melissa Williams | Physician Assistant | 265 N Broadway, Portland, OR 97227-1800 | 2007-11-29 |
| 1063612455 | Donald R Noel | Physician Assistant | 10101 Se Main St Ste 3008, Portland, OR 97216-2458 | 2007-07-23 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.