Organization
TWO RIVERS PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
C. THOMAS PROVENZANO MPT (OWNER)
(503) 445-7878
Entity
Organization
Contact information
Practice address
7522 N LOMBARD ST STE A, PORTLAND, OR 97203-3235
(503) 445-7878
(503) 445-7879
Mailing address
7522 N LOMBARD ST STE A, PORTLAND, OR 97203-3235
(503) 445-7878
(503) 445-7879
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
38130399
OR
Other
Enumeration date
02/12/2007
Last updated
04/10/2008
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