Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fountain of Youth Physical Therapy LLC

Organization Physical Therapist · NPI 1801115183

Fountain of Youth Physical Therapy LLC is a Physical Therapist in Tigard, Oregon. Licensed in Oregon. Registered with an NPI since 2010.

Licensed in
OR
In the registry since
2010
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

9860 SW Hall Blvd Ste A3
Tigard, OR 97223-8896
Phone: (503) 902-2123
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 4954 (OR)

Record details

NPI number1801115183
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Laura Waliczek — Physical Therapist · (503) 327-4195
NPI enumeratedMay 25, 2010
Last updated in NPPESMay 25, 2010
Mailing address664 Sw Rustica Ter, Portland, OR 97225-7057

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