111TH Square Fitness and Therapy, LLC
Organization Active NPI Physical Therapist · Portland, OR
NPI 1750521985 · NPPES record last updated Feb 27, 2009
Key facts
- NPI
- 1750521985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 0355 (OR)
- Legal business name
- 111TH SQUARE FITNESS AND THERAPY, LLC
- Practice address
- 11126 NE Halsey St
Portland, OR 97220-2021 - Phone
- (503) 256-5200
- Fax
- (503) 253-7958
- NPI assigned
- Feb 27, 2009
- Organization subpart
- No
Authorized official
- Name
- Ms. Linda Josephine Sanchez
- Title
- Maker
- Phone
- (503) 256-5200
National Provider Directory
Locations
11126 NE Halsey St
Portland, OR 97220
Phone (503) 256-5200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 0355 | OR | Yes |
| Athletic Trainer |
2255A2300X | 1333261 | OR | |
| Massage Therapist |
225700000X | 15397 | OR |
Addresses
Primary practice location
11126 NE Halsey St
Portland, OR 97220-2021
Mailing address
11126 NE Halsey St
Portland, OR 97220-2021
Phone (503) 256-5200
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.