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General NPI Number Information
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NPI Number | 1306394846
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Entity Type | Organization
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Legal Business Name | FUERZA PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 1720 SE HAIG ST
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City | PORTLAND
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State | OR
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Zip | 97202-2852
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Country | US
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Telephone | 305-979-9836
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Fax |
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Provider Business Mailing Address
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Address Line | 6315 SE 23RD AVE
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City | PORTLAND
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State | OR
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Zip | 97202-5449
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Country | US
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Telephone | 305-979-9836
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST AND OWNER
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Name | NATALIE SAN ANDRES
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Credential | PT, DPT
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Telephone | 305-979-9836
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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 | 60426
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License Number State | OR
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