Organization
TRACING BETA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON BOUWKAMP PT, DPT, MS, CSCS (PHYSICAL THERAPIST AND OWNER)
(352) 219-5930
Entity
Organization
Contact information
Practice address
2801 15TH PL, FOREST GROVE, OR 97116-3107
(352) 219-5930
Mailing address
2801 15TH PL, FOREST GROVE, OR 97116-3107
(352) 219-5930
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861896185
—
OR
Enumeration date
01/03/2022
Last updated
01/08/2022
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