Healthcare Provider Details

I. General information

NPI: 1295428241
Provider Name (Legal Business Name): URRUTIA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 MONMOUTH ST
INDEPENDENCE OR
97351-1126
US

IV. Provider business mailing address

609 S 4TH ST
INDEPENDENCE OR
97351-1915
US

V. Phone/Fax

Practice location:
  • Phone: 562-507-1140
  • Fax:
Mailing address:
  • Phone: 541-327-4797
  • Fax: 503-506-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DALTON URRUTIA
Title or Position: OWNER
Credential: MPT
Phone: 541-981-4434