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Organization
CHILDRENS INTENSIVE THERAPY NORTHWEST
Active
Organization
CHILDRENS INTENSIVE THERAPY NORTHWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARREN DAVID BRAULT (OWNER)
(971) 570-5043
Entity
Organization
Contact information
Practice address
7203 SE RAYMOND ST, PORTLAND, OR 97206-4323
(503) 895-1320
(503) 296-2319
Mailing address
12948 SE WINSTON RD, DAMASCUS, OR 97089-7606
(971) 570-5043
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4970
OR
2251P0200X
Pediatric Physical Therapist
5680
OR
Other
Enumeration date
09/11/2009
Last updated
07/17/2013
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