Healthcare Provider Details

I. General information

NPI: 1043146855
Provider Name (Legal Business Name): RYLEE PITTULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST STE 103
GRESHAM OR
97030-8327
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 503-328-0222
  • Fax: 503-328-0223
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66147
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: