Individual
GREG S. MACKNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4016 NE FREMONT ST, PORTLAND, OR 97212-1952
(971) 678-7422
Mailing address
5020 SE TOLMAN ST, PORTLAND, OR 97206-6974
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8473
OR
Other
Enumeration date
09/24/2007
Last updated
06/10/2015
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