Providence Health & Services - Oregon

NPI #1104109677 in Vancouver, Washington

Provider Information

NPI Number: 1104109677
Entity Type: Organization
Organization Name: Providence Health & Services - Oregon
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDENCE HEALTH & SERVICES - OREGON
Primary Specialty: Physical Therapist
Enumeration Date: Sep 21, 2011
Last Updated: May 14, 2025

Practice Location

Address: 3101 SE 192ND AVE
Address 2: SUITE 104
City: Vancouver
State: Washington
ZIP Code: 98683-1442
Phone: (360) 553-7480

Authorized Official

Name: DONALD W ANDERSON JR.
Title: ASSISTANT SECRETARY ENROLLMENTS
Phone: (425) 358-9786

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Speech-Language Pathologist	235Z00000X
Physical Therapist	225100000X	Primary

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