Provider Demographics
NPI:1851982847
Name:HUMAN POTENTIAL, LLC
Entity Type:Organization
Organization Name:HUMAN POTENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-485-8134
Mailing Address - Street 1:20894 SW EGGERT WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2162
Mailing Address - Country:US
Mailing Address - Phone:360-485-8134
Mailing Address - Fax:
Practice Address - Street 1:2020 NE ALOCLEK DR STE 105
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8053
Practice Address - Country:US
Practice Address - Phone:360-485-8134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy