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General NPI Number Information
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NPI Number | 1710496344
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Entity Type | Individual
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Provider Name | ANDREW GRANT ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 3934 NE MARTIN LUTHER KING BLVD SUITE 203
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City | PORTLAND
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State | OR
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Zip | 97212
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Country | US
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Telephone | 503-223-1856
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Fax | 503-223-1765
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Provider Business Mailing Address
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Address Line | 3934 NE MARTIN LUTHER KING BLVD SUITE 203
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City | PORTLAND
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State | OR
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Zip | 97212
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Country | US
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Telephone | 503-223-1856
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Fax | 503-223-1765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 65668
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070023337
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.02337
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License Number State | IL
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