Provider Demographics
NPI:1427225606
Name:KOFOED ENTEPRISES PC
Entity Type:Organization
Organization Name:KOFOED ENTEPRISES PC
Other - Org Name:PORTLAND PERFORMING ARTS INJURIES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOFOED
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-224-2222
Mailing Address - Street 1:1020 SW TAYLOR STREET SUITE 665
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2529
Mailing Address - Country:US
Mailing Address - Phone:503-224-2222
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR STREET SUITE 665
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2529
Practice Address - Country:US
Practice Address - Phone:503-224-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16622251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty