Healthcare Provider Details

I. General information

NPI: 1356969976
Provider Name (Legal Business Name): READYGO PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 SE 69TH AVE
PORTLAND OR
97215-2120
US

IV. Provider business mailing address

904 SE 69TH AVE
PORTLAND OR
97215-2120
US

V. Phone/Fax

Practice location:
  • Phone: 631-742-3725
  • Fax:
Mailing address:
  • Phone: 631-742-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ORELLI
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 425-331-9098