Provider Demographics
NPI:1881040731
Name:DEBORAH THRALL PT, LLC
Entity Type:Organization
Organization Name:DEBORAH THRALL PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:CARPENTER
Authorized Official - Last Name:THRALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-324-7842
Mailing Address - Street 1:24020 NW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-9266
Mailing Address - Country:US
Mailing Address - Phone:503-324-7842
Mailing Address - Fax:503-207-6185
Practice Address - Street 1:2077 NW TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8938
Practice Address - Country:US
Practice Address - Phone:503-324-7842
Practice Address - Fax:503-207-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy