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Organization

TABOR PEDIATRIC PHYSICAL THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EMILY LOUISE LIGHTHIPE DPT (PHYSICAL THERAPIST)
(503) 522-1359
Entity
Organization

Contact information

Practice address
2224 SE 53RD AVE, PORTLAND, OR 97215-3916
(503) 522-1359
Mailing address
2224 SE 53RD AVE, PORTLAND, OR 97215-3916
(503) 522-1359

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1063626034
OR
Enumeration date
03/07/2019
Last updated
03/07/2019
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