Healthcare Provider Details

I. General information

NPI: 1528228574
Provider Name (Legal Business Name): GARY CURTIS LUND PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 ARLETA AVE NE
KEIZER OR
97303-4758
US

IV. Provider business mailing address

10220 SW GREENBURG RD LINCOLN CENTER 3, SUITE 201
PORTLAND OR
97223-5503
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-0177
  • Fax:
Mailing address:
  • Phone: 503-570-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0537
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: