Provider Demographics
NPI:1225844970
Name:ENHANCED PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:ENHANCED PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:SHIYOMURA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:971-910-6265
Mailing Address - Street 1:2382 NW UPAS WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6237
Mailing Address - Country:US
Mailing Address - Phone:971-910-6265
Mailing Address - Fax:
Practice Address - Street 1:2382 NW UPAS WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6237
Practice Address - Country:US
Practice Address - Phone:971-910-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy