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General NPI Number Information
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NPI Number | 1639940984
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Entity Type | Organization
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Legal Business Name | HUMA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1625 SE LAFAYETTE ST
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City | PORTLAND
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State | OR
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Zip | 97202-3862
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Country | US
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Telephone | 503-208-6617
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Fax | 503-270-3629
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Provider Business Mailing Address
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Address Line | 7080 SE OGDEN ST
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City | PORTLAND
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State | OR
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Zip | 97206-7384
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Country | US
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Telephone | 503-208-6617
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY/CEO
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Name | JAMIE COWAN
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Credential | DPT
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Telephone | 503-208-6617
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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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Taxonomy #2
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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 |
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