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General NPI Number Information
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NPI Number | 1164899373
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Entity Type | Organization
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Legal Business Name | ROOT & BRANCH PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1305 SE MLK JR BLVD STE 101
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City | PORTLAND
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State | OR
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Zip | 97214-3457
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Country | US
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Telephone | 503-577-0318
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Fax | 503-710-9221
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Provider Business Mailing Address
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Address Line | 1305 SE MLK JR BLVD STE 101
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City | PORTLAND
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State | OR
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Zip | 97214-3457
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Country | US
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Telephone | 503-577-0318
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Fax | 503-710-9221
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Authorized Official
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Title or Position | OWNER
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Name | ALEX DELAPAZ
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Credential | PT, DPT
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Telephone | 503-577-0318
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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 | 60188
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60188
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License Number State | OR
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