Organization
PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF VANCOUVER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY DEAN KRAUT (MANAGING MEMBER)
(503) 740-8847
Entity
Organization
Contact information
Practice address
805 BROADWAY ST, VANCOUVER, WA 98660-3213
(360) 823-0138
(360) 823-0141
Mailing address
PO BOX 52194, DEPT CODE 963, PHOENIX, AZ 85072-2194
(503) 489-1781
(503) 489-1650
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
602338111
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7122260
—
WA
Enumeration date
03/31/2006
Last updated
07/25/2008
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