1902253008 NPI number — TITAN PHYSICAL THERAPY SERVICES, LLC

Table of content: (NPI 1902253008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902253008 NPI number — TITAN PHYSICAL THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TITAN PHYSICAL THERAPY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICAL THERAPY AT THE MAC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902253008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16623 SW OYSTERCATCHER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97007-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-519-0011
Provider Business Mailing Address Fax Number:
503-590-3687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1849 SW SALMON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-519-0011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
JAY
Authorized Official Middle Name:
BRENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-519-0011

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  06984 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com