Healthcare Provider Details

I. General information

NPI: 1497872022
Provider Name (Legal Business Name): TRAILS END PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 WASHINGTON ST
OREGON CITY OR
97045-1450
US

IV. Provider business mailing address

1506 WASHINGTON ST
OREGON CITY OR
97045-1450
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-6777
  • Fax: 503-655-6778
Mailing address:
  • Phone: 503-655-6777
  • Fax: 503-655-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1851
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10635
License Number StateOR

VIII. Authorized Official

Name: DAWN MARIE KLEIN
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 503-655-6777