NPI 1750521985 · live from the CMS NPI Registry
111th Square Fitness And Therapy, LLC
Physical Therapist in Portland, OR. National Provider Identifier 1750521985, active.
NPI record
| NPI | 1750521985 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 11126 Ne Halsey St, Portland, OR 97220 |
| Practice phone | 503-256-5200 |
| Enumerated | February 27, 2009 |
| Last updated | February 27, 2009 |
| Authorized official | Linda Sanchez, Maker |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist | 225700000X | 15397 (OR) |
| Specialist/Technologist, Athletic Trainer | 2255A2300X | 1333261 (OR) |
| Physical Therapist primary | 225100000X | 0355 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.