Individual
MR. MARK LAWRENCE PIETROK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
0615 SW PALATINE HILL RD, PORTLAND, OR 97219-7879
(503) 768-7065
(503) 768-7058
Mailing address
11149 SW MATZEN DR, WILSONVILLE, OR 97070-8574
(503) 682-1622
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-125479
OR
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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