Organization
GREEN HERON PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO URDANETA-MONCADA DPT (OWNER, PHYSICAL THERAPIST)
(661) 717-9692
Entity
Organization
Contact information
Practice address
1706 NW 24TH AVE UNIT 96034, PORTLAND, OR 97296-6613
(661) 717-9692
Mailing address
PO BOX 96034, PORTLAND, OR 97296-6000
(661) 717-9692
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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