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General NPI Number Information
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NPI Number | 1922235738
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Entity Type | Organization
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Legal Business Name | PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF BATTLE GROUND
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 1902 SW 9TH AVE
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City | BATTLE GROUND
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State | WA
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Zip | 98604-3286
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Country | US
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Telephone | 503-489-1174
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Fax | 503-489-1650
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Provider Business Mailing Address
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Address Line | 1480 NE VILLAGE ST
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City | FAIRVIEW
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State | OR
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Zip | 97024-3827
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Country | US
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Telephone | 503-489-1174
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Fax | 503-489-1650
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Authorized Official
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Title or Position | OWNER
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Name | MR. LARRY DEAN KROUT
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Credential |
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Telephone | 503-489-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | WA
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