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General NPI Number Information
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NPI Number | 1487630240
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ASSOCIATES INC
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 960 S BROADWAY AVE STE 200
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City | BOISE
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State | ID
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Zip | 83706-3600
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Country | US
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Telephone | 208-433-9211
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Fax | 208-433-9241
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Provider Business Mailing Address
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Address Line | 16083 SW UPPER BOONES FERRY RD STE 300
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City | TIGARD
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State | OR
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Zip | 97224-7736
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Country | US
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Telephone | 800-219-8835
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Fax | 503-443-1402
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Authorized Official
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Title or Position | INFORMATION SYSTEMS DIRECTOR
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Name | MR. TODD ROBERT GIFFORD
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Credential | PT
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Telephone | 503-443-6156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | ID
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