Organization
HOLOGRAPHIC BODY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM PERSINGER LMT (OWNER)
(541) 954-7091
Entity
Organization
Contact information
Practice address
3014 NE KILLINGSWORTH, PORTLAND, OR 97211
(541) 954-7091
Mailing address
3834 NE SIMPSON ST, PORTLAND, OR 97211-7961
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356065692
NPI
OR
Enumeration date
11/16/2023
Last updated
11/16/2023
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