Healthcare Provider Details

I. General information

NPI: 1225617210
Provider Name (Legal Business Name): EMERGENCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 SW VETERANS WAY STE 1
REDMOND OR
97756-6408
US

IV. Provider business mailing address

494 SW VETERANS WAY STE 1
REDMOND OR
97756-6408
US

V. Phone/Fax

Practice location:
  • Phone: 541-338-7088
  • Fax: 541-345-3559
Mailing address:
  • Phone: 541-338-7088
  • Fax: 541-345-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ROACH
Title or Position: CO-OWNER
Credential: DPT
Phone: 541-338-7088