# ADVANCE SPORTS & SPINE THERAPY LLC

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

## Provider details

- **NPI number:** 1831312818
- **Authorized official:** MR. NOEL MARCEL TENOSO P.T. (PT, OWNER)
- **Authorized official phone:** (503) 723-0347

## Contact information

- **Practice address:** 1554 GARDEN ST \# 103, WEST LINN, OR 97068-3278
- **Practice address phone:** (503) 723-0347
- **Practice address fax:** (503) 655-9305
- **Mailing address:** 1554 GARDEN ST STE 103, WEST LINN, OR 97068-3278
- **Mailing address phone:** (503) 723-0347
- **Mailing address fax:** (503) 655-9305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | OR | — |
| 225100000X | Physical Therapist | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 08/03/2023