MEDICARE: THERAPEUTIC ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG5282	OTHER	OR	RR MEDICARE
3	CG0694	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0334539	OTHER	OR	WA L&I

General Provider Information

NPI Number	:	1205027547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	SUITE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	503-443-6156
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	145 MYRTLE ST
Second Line	:	SUITE 106
City	:	SUTHERLIN
State	:	OR
Zip	:	97479-9113
Country	:	US
Telephone Number	:	541-459-8459
Fax Number	:	541-459-4393

Authorized Official
Title or Position	:	COO
Name	:	TODD ROBERT GIFFORD
Credential	:	PT
Telephone Number	:	503-443-6156

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	10/25/2016

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Directions to “THERAPEUTIC ASSOCIATES, INC ” Practice Location

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