Healthcare Provider Details

I. General information

NPI: 1912827593
Provider Name (Legal Business Name): VANGUARD PERFORMANCE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12279 SW 131ST AVE
TIGARD OR
97223-7807
US

IV. Provider business mailing address

12279 SW 131ST AVE
TIGARD OR
97223-7807
US

V. Phone/Fax

Practice location:
  • Phone: 423-384-3692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW ROBERT DUNN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 423-384-3692