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General NPI Number Information
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NPI Number | 1063802841
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Entity Type | Organization
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Legal Business Name | SOUND BODY LLC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 2240 N INTERSTATE AVE SUITE 280
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City | PORTLAND
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State | OR
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Zip | 97227-1769
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Country | US
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Telephone | 971-279-4268
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Fax | 971-223-7122
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Provider Business Mailing Address
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Address Line | 2240 N INTERSTATE AVE SUITE 280
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City | PORTLAND
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State | OR
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Zip | 97227-1769
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Country | US
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Telephone | 971-279-4268
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Fax | 971-223-7122
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE LYTTLE
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Credential | PT
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Telephone | 971-279-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 261QP2000X
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License Number State | OR
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