Provider Demographics
NPI:1043412000
Name:JORGENSEN, COLBIE J (PT)
Entity Type:Individual
Prefix:
First Name:COLBIE
Middle Name:J
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 SW GREENBURG RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6453
Mailing Address - Country:US
Mailing Address - Phone:503-620-5556
Mailing Address - Fax:503-624-0118
Practice Address - Street 1:11900 SW GREENBURG RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6453
Practice Address - Country:US
Practice Address - Phone:503-620-5556
Practice Address - Fax:503-624-0118
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76253602401225100000X
OR60953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist