Healthcare Provider Details

I. General information

NPI: 1497172373
Provider Name (Legal Business Name): KJB CONSULTING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST STE 202
PORTLAND OR
97210-2863
US

IV. Provider business mailing address

2525 NW LOVEJOY ST STE 202
PORTLAND OR
97210-2863
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-1856
  • Fax: 503-223-1765
Mailing address:
  • Phone: 503-223-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number60504
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number61700
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number06391
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number05662
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number60214
License Number StateOR

VIII. Authorized Official

Name: BRYAN LANG
Title or Position: CEO
Credential: DPT
Phone: 503-223-1856