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General NPI Number Information
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NPI Number | 1134316268
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Entity Type | Organization
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Legal Business Name | QUANTUM THERAPY PC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 4465 SW 109TH AVE SUITE D
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City | BEAVERTON
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State | OR
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Zip | 97005-3024
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Country | US
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Telephone | 503-602-9197
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Fax |
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Provider Business Mailing Address
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Address Line | 19045 SW MADELINE ST
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City | BEAVERTON
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State | OR
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Zip | 97007-3004
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Country | US
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Telephone | 503-602-9197
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE MERKL
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Credential | PT
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Telephone | 503-602-9197
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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 | 5984
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License Number State | OR
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