Individual
JACOB STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
710 NE HOLLADAY ST, PORTLAND, OR 97232-2168
(503) 949-1727
Mailing address
710 NE HOLLADAY ST # 150, PORTLAND, OR 97232-2168
(503) 949-1727
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
60726
OR
2251S0007X
Sports Physical Therapist
Primary
—
—
Other
Enumeration date
08/19/2014
Last updated
01/21/2025
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