Provider Demographics
NPI:1871717611
Name:WALTON PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity type:Organization
Organization Name:WALTON PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:503-639-2118
Mailing Address - Street 1:17400 SW UPPER BOONES FERRY RD.
Mailing Address - Street 2:SUITE 280
Mailing Address - City:DURHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17400 SW UPPER BOONES FERRY RD.
Practice Address - Street 2:SUITE 280
Practice Address - City:DURHAM
Practice Address - State:OR
Practice Address - Zip Code:97224-7216
Practice Address - Country:US
Practice Address - Phone:503-639-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCB6469OtherMEDICARE RAILROAD PIN
ORR109628Medicare ID - Type Unspecified