Organization
CHILDREN'S INTENSIVE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN BRAULT (PRESIDENT/CLINIC OWNER)
(503) 895-1320
Entity
Organization
Contact information
Practice address
7203 SE RAYMOND ST, PORTLAND, OR 97206-4323
(503) 895-1320
(503) 296-2319
Mailing address
7203 SE RAYMOND ST, PORTLAND, OR 97206-4323
(503) 895-1320
(503) 296-2319
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
60716
OR
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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