# NEW LEAF PHYSICAL AND MASSAGE THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003135658
- **Authorized official:** MARY GRAMLING (PRESIDENT)
- **Authorized official phone:** (503) 318-0654

## Contact information

- **Practice address:** 4050 NE BROADWAY ST, PORTLAND, OR 97232-1828
- **Practice address phone:** (503) 318-0654
- **Mailing address:** 2734 SE 47TH AVE, PORTLAND, OR 97206-1547
- **Mailing address phone:** (503) 657-8663
- **Mailing address fax:** (503) 723-3180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/21/2010
- **Last updated:** 06/16/2010