Provider Demographics
NPI:1497172373
Name:KJB CONSULTING CORPORATION
Entity Type:Organization
Organization Name:KJB CONSULTING CORPORATION
Other - Org Name:WHOLE BODY HEALTH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:503-223-1856
Mailing Address - Street 1:2525 NW LOVEJOY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2863
Mailing Address - Country:US
Mailing Address - Phone:503-223-1856
Mailing Address - Fax:
Practice Address - Street 1:2525 NW LOVEJOY ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2863
Practice Address - Country:US
Practice Address - Phone:503-223-1856
Practice Address - Fax:503-223-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60214261QP2000X
OR06391261QP2000X
OR05662261QP2000X
OR60504261QP2000X
OR61700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675564Medicaid