Healthcare Provider Details

I. General information

NPI: 1649108663
Provider Name (Legal Business Name): DUSTIN RAY ROHDE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14711 FRYELANDS BLVD SE STE 153
MONROE WA
98272-2950
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD STE 300
PORTLAND OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-4892
  • Fax: 360-794-4679
Mailing address:
  • Phone: 503-443-6156
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: