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General NPI Number Information
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NPI Number | 1962901637
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Entity Type | Organization
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Legal Business Name | EQUIPPED MOTION INCORPORATED
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 8628 SE 17TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-0000
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Country | US
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Telephone | 503-210-9987
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Fax | 503-587-5994
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Provider Business Mailing Address
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Address Line | 8628 SE 17TH AVE
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City | PORTLAND
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State | OR
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Zip | 97202-0000
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Country | US
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Telephone | 503-312-6048
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Fax | 503-987-5994
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. CALEB JOSEPH WRIGHT
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Credential | PT, DPT, OCS
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Telephone | 503-312-6048
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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 | 5675
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License Number State | OR
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