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General NPI Number Information
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NPI Number | 1992766612
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Entity Type | Organization
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Legal Business Name | CANBY PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 308 N IVY ST
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City | CANBY
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State | OR
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Zip | 97013-3704
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Country | US
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Telephone | 503-263-6786
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Fax | 503-263-6451
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Provider Business Mailing Address
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Address Line | PO BOX 52194 DEPT CODE 960
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City | PHOENIX
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State | AZ
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Zip | 85072-2194
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Country | US
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Telephone | 503-489-1781
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Fax | 503-489-1650
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. LARRY DEAN KRAUT
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Credential |
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Telephone | 503-740-8847
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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 | 3131
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License Number State | OR
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