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General NPI Number Information
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NPI Number | 1639909047
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Entity Type | Organization
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Legal Business Name | RESILIENT RUNNER HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1260 SE LAMBERT ST STE 101
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City | PORTLAND
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State | OR
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Zip | 97202-6386
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Country | US
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Telephone | 503-482-7234
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Fax | 503-482-7232
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Provider Business Mailing Address
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Address Line | 333 S STATE ST STE V337
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3932
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Country | US
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Telephone | 503-482-7234
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Fax | 503-482-7232
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER DAVIS
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Credential | PT, DPT, OCS
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Telephone | 503-482-7234
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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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