Basic Information
Provider Information | |||||||||
NPI: | 1689041139 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THERAPEUTIC ASSOCIATES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TAI - BRIDLE TRAILS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 16083 SW UPPER BOONES FERRY RD STE 300 | ||||||||
Address2: |   | ||||||||
City: | TIGARD | ||||||||
State: | OR | ||||||||
PostalCode: | 972247736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002198835 | ||||||||
FaxNumber: | 5036399699 | ||||||||
Practice Location | |||||||||
Address1: | 6509 132ND AVE NE | ||||||||
Address2: |   | ||||||||
City: | KIRKLAND | ||||||||
State: | WA | ||||||||
PostalCode: | 980338628 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4255569891 | ||||||||
FaxNumber: | 4255569896 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2015 | ||||||||
LastUpdateDate: | 10/26/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GIFFORD | ||||||||
AuthorizedOfficialFirstName: | TODD | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | COO | ||||||||
AuthorizedOfficialTelephone: | 8002198835 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.