Healthcare Provider Details

I. General information

NPI: 1386584092
Provider Name (Legal Business Name): KATHERINE ANNA GRANDLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N MOLALLA AVE
MOLALLA OR
97038-8885
US

IV. Provider business mailing address

13623 S MULINO RD
MULINO OR
97042-9601
US

V. Phone/Fax

Practice location:
  • Phone: 503-698-5500
  • Fax: 503-698-5501
Mailing address:
  • Phone: 503-698-5500
  • Fax: 503-698-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65946
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: