Provider Demographics
NPI:1306050646
Name:PEDIATRIC THERAPYWORKS
Entity type:Organization
Organization Name:PEDIATRIC THERAPYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:CULTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-819-2707
Mailing Address - Street 1:30714 SE DODGE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8961
Mailing Address - Country:US
Mailing Address - Phone:503-819-2707
Mailing Address - Fax:
Practice Address - Street 1:30714 SE DODGE PARK BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8961
Practice Address - Country:US
Practice Address - Phone:503-819-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18932251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty