MEDICARE: STRIDE STRONG PHYSICAL THERAPY LLC

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	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1215295274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIDE STRONG PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	2350 NE GRIFFIN OAKS ST STE 100
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-2374
Country	:	US
Telephone Number	:	503-208-6278
Fax Number	:	503-208-6276

Provider Business Practice Location Address
First Line	:	12849 NW CORNELL RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-5813
Country	:	US
Telephone Number	:	503-208-6278
Fax Number	:	503-208-6276

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT HOLLAND
Credential	:
Telephone Number	:	503-208-6278

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	08/17/2022

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