Provider Demographics
NPI:1639909047
Name:RESILIENT RUNNER HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:RESILIENT RUNNER HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:503-482-7234
Mailing Address - Street 1:333 S STATE ST STE V337
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3932
Mailing Address - Country:US
Mailing Address - Phone:503-482-7234
Mailing Address - Fax:503-482-7232
Practice Address - Street 1:1260 SE LAMBERT ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6386
Practice Address - Country:US
Practice Address - Phone:503-482-7234
Practice Address - Fax:503-482-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy