Provider Demographics
NPI:1265814735
Name:PT EN ROUTE, LLC
Entity Type:Organization
Organization Name:PT EN ROUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-803-4279
Mailing Address - Street 1:3057 NW OVERLOOK DR APT 1415
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7217
Mailing Address - Country:US
Mailing Address - Phone:503-803-4279
Mailing Address - Fax:
Practice Address - Street 1:3057 NW OVERLOOK DR APT 1415
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7217
Practice Address - Country:US
Practice Address - Phone:503-803-4279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5080261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy