| 360 Degree Sports Medicine & Spine Therapy Llc | |
|
1215 Se 8th Ave., Suite D, Portland, OR 97214 | |
| (503) 248-0360 | |
| (503) 334-3675 |
| Full Name | 360 Degree Sports Medicine & Spine Therapy Llc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist - Orthopedic |
| Location | 1215 Se 8th Ave., Portland, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528268588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2251X0800X | Physical Therapist - Orthopedic | (* (Not Available)) | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | 3018 (Oregon) | Secondary |
| Provider Name | Michelle Coffman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1821146366 PECOS PAC ID: 7113959255 Enrollment ID: I20080428000108 |
| Provider Name | Candis R Synsvoll |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1922156363 PECOS PAC ID: 2567629801 Enrollment ID: I20120130000200 |
| Provider Name | Joanne L Siegel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386989283 PECOS PAC ID: 5698992881 Enrollment ID: I20140812001694 |
| Provider Name | Scott J Puracchio |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912423138 PECOS PAC ID: 2961769351 Enrollment ID: I20171120000543 |
| Provider Name | Tara A Harrington |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144860024 PECOS PAC ID: 3678999828 Enrollment ID: I20200818002893 |
| Provider Name | Erich H Drossel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316615701 PECOS PAC ID: 3779971957 Enrollment ID: I20211020000962 |
| Provider Name | Gavin Klumpp |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1457923294 PECOS PAC ID: 7719385434 Enrollment ID: I20221012003412 |
| Provider Name | Brian Ta |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1689390973 PECOS PAC ID: 3375908429 Enrollment ID: I20230425002755 |
| Provider Name | Caitlin A Wade |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962286583 PECOS PAC ID: 3971959511 Enrollment ID: I20231102000741 |
| Provider Name | Shalini R Grover |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568237105 PECOS PAC ID: 7911344494 Enrollment ID: I20240319004093 |
| Mailing Address | Practice Location Address |
|---|---|
| 360 Degree Sports Medicine & Spine Therapy Llc 1215 Se 8th Ave., Suite D, Portland, OR 97214 Ph: (503) 248-0360 | 360 Degree Sports Medicine & Spine Therapy Llc 1215 Se 8th Ave., Suite D, Portland, OR 97214 Ph: (503) 248-0360 |
Jonathan Rex Gustavson, MSPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3426 Ne 62nd Ave, Portland, OR 97213 Phone: 503-312-3443 | |
Ms. Ruth A Hurst, P.T., G.C.F.P. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7721 Sw 34th Ave, Portland, OR 97219 Phone: 503-452-7767 | |
Ms. Molly Anne Bredenberg, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 5050 Ne Hoyt St, Portland, OR 97213 Phone: 503-215-0424 | |
David Genco Jr., DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 319 Ne Russet St, Portland, OR 97211 Phone: 503-289-5571 | |
Jenna Valentine, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 9204 Se Mitchell St, Portland, OR 97266 Phone: 503-777-6746 | |
Ariel Witkin, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1515 Nw 18th Ave Ste 400, Portland, OR 97209 Phone: 503-228-1306 Fax: 503-228-1307 | |
Brian Carper, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 300 N Graham St Ste 430, Portland, OR 97227 Phone: 503-413-1500 |