Organization
ADVANCE SPORTS & SPINE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NOEL MARCEL TENOSO P.T. (PT, OWNER)
(503) 723-0347
Entity
Organization
Contact information
Practice address
1554 GARDEN ST # 103, WEST LINN, OR 97068-3278
(503) 723-0347
(503) 655-9305
Mailing address
1554 GARDEN ST STE 103, WEST LINN, OR 97068-3278
(503) 723-0347
(503) 655-9305
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
OR
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
04/10/2007
Last updated
08/03/2023
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