| NPI | 1255473047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C. THOMAS PROVENZANO Owner 503-445-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: OR 38130399) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2008-04-10 |