# VITALITY PHYSICAL THERAPY NORTHWEST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144738790
- **Authorized official:** COLLEEN GILROY (OWNER)
- **Authorized official phone:** (503) 577-2706

## Contact information

- **Practice address:** 12755 SW 69TH AVE, PORTLAND, OR 97223-8373
- **Practice address phone:** (503) 577-2706
- **Mailing address:** 7722 SE 31ST AVE, PORTLAND, OR 97202-8537
- **Mailing address phone:** (503) 577-2706

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/17/2018
- **Last updated:** 10/24/2018