Healthcare Provider Details

I. General information

NPI: 1144636358
Provider Name (Legal Business Name): THERAPEUTIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 05/23/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N FISHER PARK WAY STE. 100
EAGLE ID
83616-4704
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: 208-939-0140
  • Fax: 208-939-0139
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HAMILTON
Title or Position: DIR PAYER & PROVIDER RELATIONS
Credential:
Phone: 503-443-6156