# ROGER MILLER LAKE OSWEGO PHYSICAL THERAPY LLC

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

## Provider details

- **NPI number:** 1760839815
- **Authorized official:** ROGER J MILLER COMP FAAOMPT (PHYSICAL THERAPIST AND OWNER)
- **Authorized official phone:** (971) 204-0600

## Contact information

- **Practice address:** 15110 BOONES FERRY RD STE 230, LAKE OSWEGO, OR 97035-3497
- **Practice address phone:** (971) 204-0600
- **Practice address fax:** (971) 204-0602
- **Mailing address:** 6464 SW BORLAND RD STE B5, TUALATIN, OR 97062-8859
- **Mailing address phone:** (971) 204-0600
- **Mailing address fax:** (971) 204-0602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | PT0851 | OR | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/18/2016
- **Last updated:** 12/01/2017