Provider Demographics
NPI:1558041459
Name:MOUNT TABOR PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MOUNT TABOR PHYSICAL THERAPY LLC
Other - Org Name:MOUNT TABOR PELVIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:503-272-1931
Mailing Address - Street 1:6807 SE ASH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1688
Mailing Address - Country:US
Mailing Address - Phone:503-432-1845
Mailing Address - Fax:
Practice Address - Street 1:6807 SE ASH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1688
Practice Address - Country:US
Practice Address - Phone:503-432-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty