Fountain of Youth Physical Therapy LLC
NPI 1801115183ActiveOrganization· Physical Therapist· Tigard, OR
Physical Therapist in Tigard, Oregon, registered in NPPES in May 2010. The authorized official on file is Laura L. Waliczek, PT, DPT, Physical Therapist.
Overview
| NPI | 1801115183 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 25, 2010 |
| Last updated in NPPES | May 25, 2010 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 4954 | OR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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