Organization
NORTHWEST PRIMARY CARE GROUP PC
Active
Other names
Northwest Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL WHITBECK (ADMINISTRATOR)
(503) 659-4777
Entity
Organization
Contact information
Practice address
12119 SE STEVENS CT, PORTLAND, OR 97266-8620
(503) 353-1278
(503) 353-1273
Mailing address
PO BOX 22075, MILWAUKIE, OR 97269-2075
(503) 659-4777
(503) 652-5223
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049072
—
OR
01
—
CE8055
RAILROAD GROUP PTAN
OR
Enumeration date
07/21/2006
Last updated
06/03/2020
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