Individual
SUR TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3101 SE 192ND AVE, VANCOUVER, WA 98683-1442
(360) 729-8010
(360) 729-8011
Mailing address
820 NW DEERFERN LOOP, CAMAS, WA 98607-8648
(360) 241-6569
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
60385496
WA
Other
Enumeration date
11/24/2025
Last updated
12/09/2025
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