Provider Demographics
NPI:1659537991
Name:TRASK RIVER THERAPY LLC
Entity Type:Organization
Organization Name:TRASK RIVER THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KNOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT LMT
Authorized Official - Phone:503-842-7305
Mailing Address - Street 1:27025 TRASK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-8988
Mailing Address - Country:US
Mailing Address - Phone:503-842-7305
Mailing Address - Fax:503-842-0447
Practice Address - Street 1:27025 TRASK RIVER RD
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-8988
Practice Address - Country:US
Practice Address - Phone:503-842-7305
Practice Address - Fax:503-842-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty