Healthcare Provider Details

I. General information

NPI: 1689539843
Provider Name (Legal Business Name): ADRIAN GONCERZEWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 MOLALLA AVE
OREGON CITY OR
97045-4004
US

IV. Provider business mailing address

58 FAIRWAY DR
NEWNAN GA
30265-5634
US

V. Phone/Fax

Practice location:
  • Phone: 503-744-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016609
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: