Healthcare Provider Details

I. General information

NPI: 1487630240
Provider Name (Legal Business Name): THERAPEUTIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S BROADWAY AVE STE 200
BOISE ID
83706-3600
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE 300
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 208-433-9211
  • Fax: 208-433-9241
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateID

VIII. Authorized Official

Name: MR. TODD ROBERT GIFFORD
Title or Position: INFORMATION SYSTEMS DIRECTOR
Credential: PT
Phone: 503-443-6156