Organization
111TH SQUARE FITNESS AND THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LINDA JOSEPHINE SANCHEZ (MAKER)
(503) 256-5200
Entity
Organization
Contact information
Practice address
11126 NE HALSEY ST, PORTLAND, OR 97220-2021
(503) 256-5200
(503) 253-7958
Mailing address
11126 NE HALSEY ST, PORTLAND, OR 97220-2021
(503) 256-5200
(503) 253-7958
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0355
OR
2255A2300X
Athletic Trainer
1333261
OR
225700000X
Massage Therapist
15397
OR
Other
Enumeration date
02/27/2009
Last updated
02/27/2009
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