Healthcare Provider Details

I. General information

NPI: 1972120541
Provider Name (Legal Business Name): CYTI PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 SW CANYON RD # 202
BEAVERTON OR
97005-2234
US

IV. Provider business mailing address

PO BOX 1310
SHERWOOD OR
97140-1310
US

V. Phone/Fax

Practice location:
  • Phone: 503-625-0152
  • Fax:
Mailing address:
  • Phone: 503-625-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUN JAE YU
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 503-625-0152