Individual
JORDAN CRAIG PRUNTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
11105 SW GREENBURG RD, TIGARD, OR 97223-5446
(971) 294-2669
Mailing address
11489 SW GABRIEL ST, TIGARD, OR 97224-4062
(971) 777-0001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
65742
OR
Other
Enumeration date
06/27/2025
Last updated
06/27/2025
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