Provider Demographics
NPI:1225617210
Name:EMERGENCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EMERGENCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-338-7088
Mailing Address - Street 1:494 SW VETERANS WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6408
Mailing Address - Country:US
Mailing Address - Phone:541-338-7088
Mailing Address - Fax:541-345-3559
Practice Address - Street 1:494 SW VETERANS WAY STE 1
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6408
Practice Address - Country:US
Practice Address - Phone:541-338-7088
Practice Address - Fax:541-345-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1215917398OtherSTATE OF OREGON
OR1952381006OtherSTATE OF OREGON