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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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