Individual
LARRY STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-9820
Mailing address
4531 SE BELMONT ST STE 100, PORTLAND, OR 97215-1675
(503) 215-9820
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
07858
OR
Other
Enumeration date
06/20/2016
Last updated
06/20/2016
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