- Practice location
- 11126 NE Halsey St, Portland, OR 97220-2021
- Phone
- 503-256-5200
- Fax
- 503-253-7958
- Last updated
- February 27, 2009
111TH Square Fitness And Therapy, LLC is a healthcare organization based in Portland, OR. 111TH Square Fitness And Therapy, LLC practices in Portland, OR. The NPI Number for 111TH Square Fitness And Therapy, LLC is 1750521985 and holds a License No. 15397 (OR). The current practice location address for 111TH Square Fitness And Therapy, LLC is 11126 NE Halsey St, Portland, OR 97220-2021 and can be reached out via phone at 503-256-5200 and via fax at 503-253-7958.
Provider Profile Details
- NPI Number
- 1750521985
- Provider Name
- 111TH Square Fitness And Therapy, LLC
- Provider Entity Type
- Organization
- Address
- 11126 NE Halsey St, Portland, OR 97220-2021
- Phone Number
- 503-256-5200
- Fax Number
- 503-253-7958
- Primary Taxonomy
- Physical Therapist · 225100000X
- Organization Subpart
- No
- Authorized Official
- Ms. Linda Josephine Sanchez · Maker · 503-256-5200
- Provider Enumeration Date
- February 27, 2009
- Last Update Date
- February 27, 2009
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 11126 NE Halsey St
Portland, OR 97220-2021 - City
- Portland
- State
- Oregon
- Zip
- 97220-2021
- Phone Number
- 503-256-5200
- Fax Number
- 503-253-7958
Provider Business Mailing Address Details
- Address
- 11126 NE Halsey St
Portland, OR 97220-2021 - City
- Portland
- State
- OR
- Zip
- 97220-2021
- Phone Number
- 503-256-5200
- Fax Number
- 503-253-7958
License Information
- License Number (1)
- 15397
- License State (1)
- OR
- Taxonomy (1)
- Massage Therapist · 225700000X
- License Number (2)
- 1333261
- License State (2)
- OR
- Taxonomy (2)
- Specialist/Technologist, Athletic Trainer · 2255A2300X
- License Number (3)
- 0355
- License State (3)
- OR
- Taxonomy (3)
- Physical Therapist · 225100000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of 111TH Square Fitness And Therapy, LLC?
The NPI number of 111TH Square Fitness And Therapy, LLC is 1750521985. It was assigned on February 27, 2009 and is currently active in the NPPES registry.
What is the specialty of 111TH Square Fitness And Therapy, LLC?
111TH Square Fitness And Therapy, LLC is registered under the primary taxonomy Physical Therapist (code 225100000X), licensed in OR under license number 15397.
Where does 111TH Square Fitness And Therapy, LLC practice?
The practice location is 11126 NE Halsey St, Portland, OR 97220-2021. The office can be reached at 503-256-5200 (phone) or 503-253-7958 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1750521985 directly on the NPPES registry website.