Provider Demographics
NPI:1558143735
Name:STABLE BODY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STABLE BODY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CORREIA-JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CERP
Authorized Official - Phone:530-638-5848
Mailing Address - Street 1:16055 SW WALKER RD STE 188
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4942
Mailing Address - Country:US
Mailing Address - Phone:530-638-5848
Mailing Address - Fax:
Practice Address - Street 1:17323 SW JAY ST APT 302
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-7628
Practice Address - Country:US
Practice Address - Phone:530-638-5848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy