# CHILDREN'S INTENSIVE THERAPY

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

## Provider details

- **NPI number:** 1982001194
- **Authorized official:** DARREN BRAULT (PRESIDENT/CLINIC OWNER)
- **Authorized official phone:** (503) 895-1320

## 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:** 7203 SE RAYMOND ST, PORTLAND, OR 97206-4323
- **Mailing address phone:** (503) 895-1320
- **Mailing address fax:** (503) 296-2319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 60716 | OR | Yes |

## Other

- **Enumeration date:** 12/03/2014
- **Last updated:** 12/03/2014