# CHILDRENS INTENSIVE THERAPY NORTHWEST

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

## Provider details

- **NPI number:** 1477886232
- **Authorized official:** MR. DARREN DAVID BRAULT (OWNER)
- **Authorized official phone:** (971) 570-5043

## Contact information

- **Practice address:** 7203 SE RAYMOND ST, PORTLAND, OR 97206-4323
- **Practice address phone:** (503) 895-1320
- **Practice address fax:** (503) 296-2319
- **Mailing address:** 12948 SE WINSTON RD, DAMASCUS, OR 97089-7606
- **Mailing address phone:** (971) 570-5043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | 4970 | OR | Yes |
| 2251P0200X | Pediatric Physical Therapist | 5680 | OR | — |

## Other

- **Enumeration date:** 09/11/2009
- **Last updated:** 07/17/2013