Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Fountain of Youth Physical Therapy LLC

Organization Physical Therapist · NPI 1801115183

Fountain of Youth Physical Therapy LLC provides Physical Therapist services 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 Not confirmed with CMS for 16 years — call before visiting
Phone: (503) 902-2123
Show map & directions

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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