Individual
JEAN ELIN BLACK-GROULX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2701 NW VAUGHN ST, SUITE 140, PORTLAND, OR 97210-5311
(503) 499-5262
(503) 813-3964
Mailing address
409 NE 126TH AVE, PORTLAND, OR 97230-2406
(503) 312-8794
(503) 256-3566
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0857
OR
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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