MEDICARE: FOUNDATIONS PEDIATRIC THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1699325530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATIONS PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 22406
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97269-2406
Country	:	US
Telephone Number	:	971-236-3036
Fax Number	:	877-335-7643

Provider Business Practice Location Address
First Line	:	4305 SE MILWAUKIE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3960
Country	:	US
Telephone Number	:	971-236-3036
Fax Number	:	877-335-7643

Authorized Official
Title or Position	:	OWNER / PHYSICAL THERAPIST
Name	:	DANIEL A QUINN
Credential	:	PT
Telephone Number	:	971-236-3036

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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Directions to “FOUNDATIONS PEDIATRIC THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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