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General NPI Number Information
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NPI Number | 1760839815
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Entity Type | Organization
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Legal Business Name | ROGER MILLER LAKE OSWEGO PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 15110 BOONES FERRY RD STE 230
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3497
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Country | US
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Telephone | 971-204-0600
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Fax | 971-204-0602
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Provider Business Mailing Address
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Address Line | 6464 SW BORLAND RD STE B5
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City | TUALATIN
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State | OR
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Zip | 97062-8859
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Country | US
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Telephone | 971-204-0600
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Fax | 971-204-0602
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Authorized Official
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Title or Position | PHYSICAL THERAPIST AND OWNER
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Name | ROGER J MILLER
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Credential | COMP FAAOMPT
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Telephone | 971-204-0600
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT0851
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License Number State | OR
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