ACTIVE EDGE PHYSICAL THERAPY & SPORTS MEDICINE P.C. (NPI# 1730324336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730324336 |
| Entity Type | Organization |
| Organization Name | ACTIVE EDGE PHYSICAL THERAPY & SPORTS MEDICINE P.C. |
| Practice Address |
1914 Willamette Falls Drive Suite 230 West Linn OR 97068 |
| Mailing Address |
4510 Riverview Ave West Linn OR 97068-3565 |
| Practice Telephone | 5033875449 |
| Practice Fax Number | 5033426846 |
| Mailing Telephone | 5033875449 |
| Mailing Fax Number | 5033426846 |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2008-12-10 |
| Authorized Official Name | MR. DANIEL C. MORLAN (PRESIDENT) |
| Authorized Official Telephone | 5036750267 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 4568 | OR | Other Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | ACTIVE EDGE PHYSICAL THERAPY & SPORTS MEDICINE P.C. | 2020 8th Avenue, Suite D, West Linn, OR 97068 |
| Street Address |
1914 WILLAMETTE FALLS DRIVE SUITE 230 |
| City | WEST LINN |
| State | OR |
| Zip Code | 97068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023678224 | Bethany Joy Bivin | Registered Nurse | 2020 8th Ave Ste 230, West Linn, OR 97068 | 2019-06-19 |
| 1932612777 | Portland Dental Works, LLC | Dentist | 1750 Mckillican, West Linn, OR 97068 | 2017-11-15 |
| 1316460702 | Cameron Johnson Dc LLC | Chiropractor | 21400 Salamo Rd, West Linn, OR 97068 | 2017-07-18 |
| 1376913301 | Genesis Medical Concepts, LLC | Durable Medical Equipment & Medical Supplies | 2020 8th Ave Ste 222, West Linn, OR 97068 | 2015-10-02 |
| 1780052977 | Amanda Carole Tipton | Chiropractor | 21860 Willamette Drive, West Linn, OR 97068 | 2015-09-04 |
| 1457766859 | Eyedeology, Inc | Optometrist | 5656 Hood St. Ste 107, West Linn, OR 97068 | 2014-06-24 |
| 1740694660 | Ariana Bissinger | Nurse Practitioner | 1148 Rosemont Rd, West Linn, OR 97068 | 2014-06-18 |
| 1154606887 | Heather Marie Ellison | Massage Therapist | 22000 Willamette Dr., #107, West Linn, OR 97068 | 2011-10-13 |
| 1336432616 | Lisa Grage | Dental Hygienist | 3551 Coeur D'alene Dr., West Linn, OR 97068 | 2011-05-19 |
| 1316240583 | David Robert Gleave | Psychologist | 1800 Blankenship Rd Ste 200, West Linn, OR 97068 | 2010-12-10 |
| Find all providers in zip 97068 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124315569 | Mingming Zhang Hohensee | Specialist | 2951 Hunter Way, West Linn, OR 97068-2241 | 2011-07-06 |
| 1528222056 | Tianna Renee Martinez | Specialist | 19691 Sun Cir, West Linn, OR 97068-1913 | 2008-07-14 |
| 1194990036 | Dominic Wilfred Hughes | Specialist | 5525 Broadway St, West Linn, OR 97068-3205 | 2008-04-22 |
| 1780805317 | Jamie Lynn Woodley | Specialist | 2500 Willamette Falls Dr, West Linn, OR 97068-4733 | 2007-05-01 |
| 1164566741 | Gordon L. Mccomb | Specialist | 806 Alicia Ct, West Linn, OR 97068-4041 | 2007-02-16 |
| 1003950684 | Gerald T. Lisac | Specialist | 276 Sw Forest Cove Rd, West Linn, OR 97068-9401 | 2007-02-16 |
| 1972688521 | Eric William Long | Specialist | 1323 Sw Schaeffer Rd, West Linn, OR 97068-9658 | 2006-10-25 |
| 1740731520 | David Francis | Specialist | 22000 Willamette Dr Ste 107, West Linn, OR 97068-3210 | 2016-10-17 |
| 1922426121 | Body, Heart &soul Massage | Specialist | 18813 Willamette Dr, West Linn, OR 97068-1711 | 2014-04-03 |
| 1821429366 | West Linn Pediatrics PC | Specialist | 1750 Blankenship Rd, Suite 275, West Linn, OR 97068-5101 | 2013-12-10 |
| Find all providers in WEST LINN | ||||
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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.