Provider Demographics
NPI:1396979761
Name:PINNACLE PHYSICAL THERAPY LLC.
Entity type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-576-0888
Mailing Address - Street 1:4025 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4859
Mailing Address - Country:US
Mailing Address - Phone:503-390-9009
Mailing Address - Fax:503-393-0834
Practice Address - Street 1:210 WEST ELLENDALE AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-0000
Practice Address - Country:US
Practice Address - Phone:503-623-2433
Practice Address - Fax:503-623-2196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-13
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty