Healthcare Provider Details

I. General information

NPI: 1659537991
Provider Name (Legal Business Name): TRASK RIVER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27025 TRASK RIVER RD
TILLAMOOK OR
97141-8988
US

IV. Provider business mailing address

27025 TRASK RIVER RD
TILLAMOOK OR
97141-8988
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-7305
  • Fax: 503-842-0447
Mailing address:
  • Phone: 503-842-7305
  • Fax: 503-842-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1696
License Number StateOR

VIII. Authorized Official

Name: MS. SUSAN DIANE KNOTTS
Title or Position: REGISTERED AGENT
Credential: P.T. L.M.T.
Phone: 503-842-7305