Provider Demographics
NPI:1093581670
Name:FREEDOM PT
Entity type:Organization
Organization Name:FREEDOM PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-592-0673
Mailing Address - Street 1:14845 NW NORTHUMBRIA LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5435
Mailing Address - Country:US
Mailing Address - Phone:773-592-0673
Mailing Address - Fax:
Practice Address - Street 1:14845 NW NORTHUMBRIA LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5435
Practice Address - Country:US
Practice Address - Phone:773-592-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty