Provider Demographics
NPI:1730915083
Name:TSL WELL LLC
Entity type:Organization
Organization Name:TSL WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FANCHO
Authorized Official - Middle Name:FEE
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:503-435-2323
Mailing Address - Street 1:3330 SE THREE MILE LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6232
Mailing Address - Country:US
Mailing Address - Phone:503-435-2323
Mailing Address - Fax:
Practice Address - Street 1:3900 KRUSE WAY PL
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2512
Practice Address - Country:US
Practice Address - Phone:503-635-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty