Individual
MR. GRANT ANDREW BORTNEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3270 LIBERTY RD S, SALEM, OR 97302
(503) 371-0779
(503) 371-0886
Mailing address
3270 LIBERTY RD S, SALEM, OR 97302
(503) 371-0779
(503) 371-0886
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05964
OR
225100000X
Physical Therapist
5964
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500622178
—
OR
Enumeration date
06/10/2009
Last updated
03/17/2017
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