Provider Demographics
NPI:1124532791
Name:JOURNEY TO HEALTH PHYSICAL THERAPY AND WELLNESS CLINIC, LLC
Entity type:Organization
Organization Name:JOURNEY TO HEALTH PHYSICAL THERAPY AND WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:AUDREEN
Authorized Official - Last Name:GRENIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:503-809-2288
Mailing Address - Street 1:15660 NW ATHENS DR APT 328
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9299
Mailing Address - Country:US
Mailing Address - Phone:503-516-5114
Mailing Address - Fax:
Practice Address - Street 1:15660 NW ATHENS DR APT 328
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9299
Practice Address - Country:US
Practice Address - Phone:503-516-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty