Organization
CUSTOM CARE PHYSICAL THERAPY, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN LEE MASON (GENERAL MANAGER)
(503) 357-1706
Entity
Organization
Contact information
Practice address
3838 PACIFIC AVE, FOREST GROVE, OR 97116-2224
(503) 357-1706
(503) 270-5023
Mailing address
3838 PACIFIC AVE, FOREST GROVE, OR 97116-2224
(503) 357-1706
(503) 270-5023
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
3440
OR
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136956
—
OR
Enumeration date
02/05/2009
Last updated
05/24/2022
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