111TH SQUARE FITNESS AND THERAPY, LLC
Organization (NPI-2)
Active
Physical Therapist
Provider Information
- NPI Number
1750521985- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 11126 NE HALSEY ST, PORTLAND, OR, 972202021
- Phone
- (503) 256-5200
- Fax
- (503) 253-7958
Specialties & Taxonomies
Massage Therapist
License: OR #15397
Specialist/Technologist, Athletic Trainer
License: OR #1333261
Physical Therapist
Primary License: OR #0355