| Organization Name: | EASTSIDE WELLNESS CENTER, LLC |
| NPI Number: | 1053504696 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NOAH I GOODWILL (OWNER) |
| Mailing Address: | 5331 Sw Macadam Ave Suite 105 Portland |
| State: | OR US |
| Postal Code: | 972396104 |
| Phone Number: | 5034457999 |
| Fax Number: | 5034457997 |
| NPI Enumeration Date: | 08/27/2007 |
| NPI Last Update Date: | 12/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 3758 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |