# PACIFIC NEURO THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Apex Performance Wellness & Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316394083
- **Authorized official:** KELLEN MASTRUD (CO-OWNER & PRESIDENT)
- **Authorized official phone:** (971) 294-2669

## Contact information

- **Practice address:** 11105 SW GREENBURG RD, TIGARD, OR 97223-5446
- **Practice address phone:** (971) 294-2669
- **Practice address fax:** (503) 746-6609
- **Mailing address:** 11105 SW GREENBURG RD, TIGARD, OR 97223-5446
- **Mailing address phone:** (971) 294-2669
- **Mailing address fax:** (503) 746-6609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/23/2016
- **Last updated:** 10/03/2022