Organization
PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF GRESHAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY DEAN KROUT (MANAGING MEMBER)
(503) 740-8847
Entity
Organization
Contact information
Practice address
25500 SE STARK ST, SUITE 103, GRESHAM, OR 97030-3331
(503) 328-0222
(503) 328-0223
Mailing address
PO BOX 52194, DEPT CODE 961, PHOENIX, AZ 85072-2194
(503) 489-1781
(503) 489-1650
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
20573
OR
Other
Enumeration date
03/31/2006
Last updated
07/25/2008
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