# CUSTOM CARE PHYSICAL THERAPY, LLC.

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

## Provider details

- **NPI number:** 1508005026
- **Authorized official:** LAUREN LEE MASON (GENERAL MANAGER)
- **Authorized official phone:** (503) 357-1706

## Contact information

- **Practice address:** 3838 PACIFIC AVE, FOREST GROVE, OR 97116-2224
- **Practice address phone:** (503) 357-1706
- **Practice address fax:** (503) 270-5023
- **Mailing address:** 3838 PACIFIC AVE, FOREST GROVE, OR 97116-2224
- **Mailing address phone:** (503) 357-1706
- **Mailing address fax:** (503) 270-5023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 3440 | OR | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/05/2009
- **Last updated:** 05/24/2022