Organization
PRO-TECH SPORTS MEDICINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GREGORY C.O. (OWNER)
(503) 699-0045
Entity
Organization
Contact information
Practice address
16679 BOONES FERRY RD, SUITE 215, LAKE OSWEGO, OR 97035-4365
(503) 699-0045
(503) 699-1911
Mailing address
16679 BOONES FERRY RD, SUITE 215, LAKE OSWEGO, OR 97035-4365
(503) 699-0045
(503) 699-1911
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035985
—
OR
01
—
081911000
BLUE CROSS PROVIDER #
OR
Enumeration date
07/14/2006
Last updated
10/29/2008
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