Provider Demographics
NPI:1558111476
Name:YUZU PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:YUZU PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TADAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:971-303-5794
Mailing Address - Street 1:2320 NE DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3127
Mailing Address - Country:US
Mailing Address - Phone:971-303-5794
Mailing Address - Fax:
Practice Address - Street 1:436 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1323
Practice Address - Country:US
Practice Address - Phone:503-305-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy