Proactive Orthopedic and Sports Physical Therapy of Gresham LLC

NPI #1467413179 in Gresham, Oregon

Provider Information

NPI Number: 1467413179
Entity Type: Organization
Organization Name: Proactive Orthopedic and Sports Physical Therapy of Gresham LLC
Primary Specialty: Clinic/Center - Physical Therapy
Enumeration Date: Mar 31, 2006
Last Updated: Jul 25, 2008

Practice Location

Address: 25500 SE STARK ST
Address 2: SUITE 103
City: Gresham
State: Oregon
ZIP Code: 97030-3331
Phone: (503) 328-0222

Authorized Official

Name: MR. LARRY DEAN KROUT
Title: MANAGING MEMBER
Phone: (503) 740-8847

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Physical Therapy — Physical Therapy	261QP2000X	Primary

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