# ROOT & BRANCH INTEGRATIVE FITNESS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ROOT & BRANCH PHYSICAL THERAPY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215490347
- **Legal business name:** ROOT & BRANCH PHYSICAL THERAPY
- **Authorized official:** ALEX DE LA PAZ PT, DPT (OWNER)
- **Authorized official phone:** (503) 577-0318

## Contact information

- **Practice address:** 1235 SE GRAND AVE, PORTLAND, OR 97214-3435
- **Practice address phone:** (503) 577-0318
- **Practice address fax:** (503) 710-9221
- **Mailing address:** 12575 SW DOUGLAS ST, PORTLAND, OR 97225-4539
- **Mailing address phone:** (503) 577-0318
- **Mailing address fax:** (503) 710-9221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 04/06/2019
- **Last updated:** 08/29/2021