Healthcare Provider Details

I. General information

NPI: 1336218197
Provider Name (Legal Business Name): MARY M GRUEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9923 SW ARCTIC DR
BEAVERTON OR
97005-4194
US

IV. Provider business mailing address

9923 SW ARCTIC DR
BEAVERTON OR
97005-4194
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-8482
  • Fax: 503-646-8153
Mailing address:
  • Phone: 503-646-8482
  • Fax: 503-646-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2794
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: