MEDICARE: PEDIATRIC THERAPYWORKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	1893	OR

General Provider Information

NPI Number	:	1306050646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPYWORKS

Provider Business Mailing Address
First Line	:	30714 SE DODGE PARK BLVD
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080-8961
Country	:	US
Telephone Number	:	503-819-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	30714 SE DODGE PARK BLVD
Second Line	:
City	:	GRESHAM
State	:	OR
Zip	:	97080-8961
Country	:	US
Telephone Number	:	503-819-2707
Fax Number	:

Authorized Official
Title or Position	:	CORPORATE PRESIDENT
Name	:	BOBBI CULTER
Credential	:	P.T.
Telephone Number	:	503-819-2707

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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