Individual
MARK DAVID BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3270 LIBERTY RD S, SALEM, OR 97302
(503) 371-0779
(503) 371-0886
Mailing address
3270 LIBERTY RD S, SALEM, OR 97302
(503) 371-0779
(503) 371-0886
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
64192
OR
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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