Provider Demographics
NPI:1760152235
Name:ROSE CITY PHYSICAL THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ROSE CITY PHYSICAL THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:LAUREL
Authorized Official - Last Name:KOLBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, DPT
Authorized Official - Phone:503-228-1306
Mailing Address - Street 1:1515 NW 18TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2516
Mailing Address - Country:US
Mailing Address - Phone:503-228-1306
Mailing Address - Fax:
Practice Address - Street 1:300 SE 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1526
Practice Address - Country:US
Practice Address - Phone:503-595-0570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty