Organization
VIVANTA NEURO GERIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINI GUPTA (PHYSICAL THERAPIST)
(503) 960-2060
Entity
Organization
Contact information
Practice address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
(503) 960-2060
Mailing address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-3822
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/18/2026
Last updated
06/18/2026
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