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Organization Active NPI

Proactive Orthopedic and Sports Physical Therapy of Gresham LLC

  • Physical Therapy Clinic/Center
  • Gresham, OR
National Provider Identifier
1467413179
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
20573 Issued in OR
Legal business name
PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF GRESHAM LLC
Practice address
25500 SE Stark St
Suite 103
Gresham, OR 97030-3331
Phone
(503) 328-0222
Fax
(503) 328-0223
NPI assigned
Mar 31, 2006
Last updated
Jul 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Larry Dean Krout
Title
Managing Member
Phone
(503) 740-8847

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 20573 OR Primary

Addresses

Primary practice location

25500 SE Stark St
Suite 103
Gresham, OR 97030-3331

Mailing address

PO Box 52194
Dept Code 961
Phoenix, AZ 85072-2194
Phone (503) 489-1781

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1467413179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52194",
            "address_2": "DEPT CODE 961",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850722194",
            "telephone_number": "503-489-1781",
            "fax_number": "503-489-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25500 SE STARK ST",
            "address_2": "SUITE 103",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303331",
            "telephone_number": "503-328-0222",
            "fax_number": "503-328-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF GRESHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "KROUT",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "503-740-8847",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "20573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.