MEDICARE: TSL WELL LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1730915083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSL WELL LLC

Provider Business Mailing Address
First Line	:	3330 SE THREE MILE LN
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-6232
Country	:	US
Telephone Number	:	503-435-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 KRUSE WAY PL
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-2512
Country	:	US
Telephone Number	:	503-635-7000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FANCHO FEE STUBBLEFIELD JR.
Credential	:
Telephone Number	:	503-435-2323

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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Directions to “TSL WELL LLC ” Practice Location

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