| Angelo Joseph Bologna, PT | |
| 282 Ne 223rd Ave, Gresham, OR 97030-8555 | |
| (503) 912-1192 | |
| (503) 912-1275 | 
| Full Name | Angelo Joseph Bologna | 
|---|---|
| Gender | Male | 
| Speciality | Physical Therapist | 
| Location | 282 Ne 223rd Ave, Gresham, Oregon | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1558843870 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 225100000X | Physical Therapist | 63365 (Oregon) | Primary | 
| 225100000X | Physical Therapist | 11781 (Tennessee) | Secondary | 
| Provider Name | Ohsu Outpatient Clinical Services Llc | 
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice | 
| Provider Identifiers | NPI Number: 1336824440 PECOS PAC ID: 7315300571 Enrollment ID: O20230906000508 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Angelo Joseph Bologna, PT 1200 Corporate Dr Ste 400, Birmingham, AL 35242-5424 Ph: (423) 682-8840 | Angelo Joseph Bologna, PT 282 Ne 223rd Ave, Gresham, OR 97030-8555 Ph: (503) 912-1192 | 
| Namita Avarsekar,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 304 Ne Hood Ave, Gresham, OR 97030 Phone: 503-666-1333 Fax: 503-666-2444 | |
| Paul Song Eo, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 24076 Se Stark St Ste 200, Gresham, OR 97030 Phone: 503-491-1666 | |
| Mr. Clem George Eischen Jr., PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 24076 Se Stark St, Gresham, OR 97030 Phone: 503-491-1666 | |
| Kaeli Frank,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7927 Se Orient Dr, Gresham, OR 97080 Phone: 503-663-0481 | |
| Stacia Akers, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24800 Se Stark St, Gresham, OR 97030 Phone: 503-413-3879 Fax: 503-413-4379 | |
| Debra Magnani, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 270 Nw Burnside Rd, Gresham, OR 97030 Phone: 503-215-9141 | |
| Kimberly Do,  Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 831 Nw Council Dr Ste 200, Gresham, OR 97030 Phone: 714-902-5157 |