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General NPI Number Information
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NPI Number | 1558143735
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Entity Type | Organization
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Legal Business Name | STABLE BODY PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 17323 SW JAY ST APT 302
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City | BEAVERTON
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State | OR
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Zip | 97003-7628
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Country | US
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Telephone | 530-638-5848
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 SW WALKER RD STE 188
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City | BEAVERTON
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State | OR
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Zip | 97006-4942
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Country | US
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Telephone | 530-638-5848
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. MICHELLE KATHRYN CORREIA-JEFFERS
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Credential | DPT, CERP
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Telephone | 530-638-5848
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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 |
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License Number State |
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