# NW SPINE MANAGEMENT REHABILITATION AND SPORTS CONDITIONING, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sports Injury Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457491169
- **Authorized official:** MRS. ANNEDRIA M BECKHAM (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (503) 227-8087

## Contact information

- **Practice address:** 9755 SW BARNES RD, SUITE 510, PORTLAND, OR 97225-6651
- **Practice address phone:** (503) 227-8087
- **Practice address fax:** (503) 227-8175
- **Mailing address:** 9755 SW BARNES RD, SUITE 510, PORTLAND, OR 97225-6651
- **Mailing address phone:** (503) 227-8087
- **Mailing address fax:** (503) 227-8175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | OR | Yes |

## Other

- **Enumeration date:** 02/08/2007
- **Last updated:** 08/22/2020