# CLACKAMAS SPORTSCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689702722
- **Authorized official:** ETHAN BENJAMIN COLLIER DPT (DOCTOR PHYSICAL THERAPY DIRECTOR)
- **Authorized official phone:** (503) 794-0103

## Contact information

- **Practice address:** 10121 SE SUNNYSIDE RD, SUITE 208, CLACKAMAS, OR 97015-5750
- **Practice address phone:** (503) 794-0103
- **Practice address fax:** (503) 794-0104
- **Mailing address:** 10121 SE SUNNYSIDE RD, SUITE 208, CLACKAMAS, OR 97015-5750
- **Mailing address phone:** (503) 794-0103
- **Mailing address fax:** (503) 794-0104

## Taxonomy

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

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 07/01/2015