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Organization
PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF GRESHAM LLC
Active
Organization
PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF GRESHAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY DEAN KROUT (MANAGING MEMBER)
(503) 740-8847
Entity
Organization
Contact information
Practice address
25500 SE STARK ST, SUITE 103, GRESHAM, OR 97030-3331
(503) 328-0222
(503) 328-0223
Mailing address
PO BOX 52194, DEPT CODE 961, PHOENIX, AZ 85072-2194
(503) 489-1781
(503) 489-1650
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
20573
OR
Other
Enumeration date
03/31/2006
Last updated
07/25/2008
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