MEDICARE: LAURA GROSSI-ROSAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251H1300X	Human Factors Physical Therapist	06451	OR
2	2251P0200X	Pediatric Physical Therapist	06451	OR

General Provider Information

NPI Number	:	1992126742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GROSSI-ROSAL

Provider Business Mailing Address
First Line	:	10175 SW BARBUR BLVD STE 214B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5955
Country	:	US
Telephone Number	:	503-997-3181
Fax Number	:	503-922-2527

Provider Business Practice Location Address
First Line	:	10175 SW BARBUR BLVD STE 214B
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97219-5955
Country	:	US
Telephone Number	:	503-997-3181
Fax Number	:	503-922-2527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	12/20/2013

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Directions to “ LAURA GROSSI-ROSAL ” Practice Location

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