Organization
REVIVE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENTON MARC BROOK (PRESIDENT)
(503) 691-2723
Entity
Organization
Contact information
Practice address
18019 SW LOWER BOONES FERRY RD, PORTLAND, OR 97224
(503) 691-2723
(503) 692-5406
Mailing address
18019 SW LOWER BOONES FERRY RD, PORTLAND, OR 97224
(503) 691-2723
(503) 692-5406
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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