Healthcare Provider Details

I. General information

NPI: 1538254602
Provider Name (Legal Business Name): KORY K BELL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11782 SW BARNES RD STE 300
PORTLAND OR
97225-5933
US

IV. Provider business mailing address

11782 SW BARNES RD STE 300
PORTLAND OR
97225-5933
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-4323
  • Fax: 503-906-4333
Mailing address:
  • Phone: 503-906-4323
  • Fax: 503-906-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3635
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: