Individual
GRETA LAUREN BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2900 SE 122ND AVE, PORTLAND, OR 97236-3206
(503) 256-6500
Mailing address
4135 NE 78TH AVE, PORTLAND, OR 97218-3925
(503) 539-2655
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6869
OR
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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