# VIVANTA NEURO GERIATRIC CLINIC

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

## Provider details

- **NPI number:** 1467388595
- **Authorized official:** MINI GUPTA (PHYSICAL THERAPIST)
- **Authorized official phone:** (503) 960-2060

## Contact information

- **Practice address:** 5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
- **Practice address phone:** (503) 960-2060
- **Mailing address:** 5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2026
- **Last updated:** 06/18/2026