Provider Demographics
NPI:1336806579
Name:WILDWOOD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WILDWOOD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND PT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:971-200-1535
Mailing Address - Street 1:825 NE 20TH AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2275
Mailing Address - Country:US
Mailing Address - Phone:971-200-1535
Mailing Address - Fax:971-231-0238
Practice Address - Street 1:825 NE 20TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2275
Practice Address - Country:US
Practice Address - Phone:971-200-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty