Provider Demographics
NPI:1144865841
Name:ST. JOHNS PHYSICAL THERAPY
Entity type:Organization
Organization Name:ST. JOHNS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-770-4215
Mailing Address - Street 1:8835 N BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2869
Mailing Address - Country:US
Mailing Address - Phone:360-770-4215
Mailing Address - Fax:
Practice Address - Street 1:8835 N BRADFORD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2869
Practice Address - Country:US
Practice Address - Phone:360-770-4215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy