Healthcare Provider Details

I. General information

NPI: 1023609435
Provider Name (Legal Business Name): MERUU CORE CHOICE REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 NW 167TH PL # 100-43
BEAVERTON OR
97006-4908
US

IV. Provider business mailing address

1975 NW 167TH PL # 100-43
BEAVERTON OR
97006-4908
US

V. Phone/Fax

Practice location:
  • Phone: 971-205-2630
  • Fax:
Mailing address:
  • Phone: 971-205-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHOSHANNA DANICA LEWIS
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 971-205-2630